Loading....

TACA National Immunity Support Package Scholarship Application

This is for the New Beginnings Immunity Support Package.

The package contains Vitamin D, Vitamin C and Zinc

Email Address*

Home Phone*

First Name*

Last Name*

Address, line 1*

Address, line 2

City*

State*

Zip Code*

IMPORTANT!

Only one scholarship per household will be considered.

Child's name*

Can your child swallow pills?*

Diagnosis*

Child's year of birth*

Number of people living in your household*

Total Annual Household Income*

Name of TACA Mentor

Please describe where you are on the autism journey.*

Explain how your child would benefit from the scholarship*

List any autism conferences you have attended.

List any TACA events you have attended*

Are you a member of the TACA Hope and Help Facebook Group?*

List any TACA Webinars you have viewed

All information submitted to TACA shall remain confidential. Please note that, pursuant to California and federal law requirements, TACA reserves the right to follow up to ensure any approved grant was actually used for its intended purpose.

I certify that the information on this form is true and complete to the best of my knowledge.

I understand that transportation or accommodations will not be provided with this grant.

By submitting this application, I hereby declare the above statements are true and correct to the best of my knowledge. I have clear and convincing documentation of all above statements and can provide these documents upon request of the TACA Scholarship Program.

Submit Application

TACA National Immunity Support Package Scholarship Application

Thank You!