WSD Foundation

Special Needs Grant Application

Guardian Name

Guardian Address

Guardian Phone

Guardian Email

Referrer Name

Referrer Email

Referrer Phone

Referrer School

Student's Name

Student's School

Description of Project or item to be purchased

Estimated Cost of Item/Project

The following questions must be addressed below...

Will the use of Christmas Tree Jubilee (CTJ) funds promote independence?

Will the use of CTJ funds enable the child to participate in family activities?

Will the use of CTJ funds enable the child to interact with peers and members of the community?

Will the use of CTJ funds enhance the child's ability to get an education?

Will the use of CTJ funds make a difference over time?

Will the use of CTJ funds enable the child to participate in meaningful work?

Will the item be primarily utilized at home or school?

Description of how you plan to use the funds.

Please provide full disclosure of all other available funding.

Total funds requested.

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