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2012 Small Grant Application Period is now open! Online Applications will be accepted from May 20, 2012 up to and including June 30, 2012.

ALL PREVIOUSLY ISSUED GRANT APPLICATIONS ARE NOW OBSOLETE.

Please review ALL the following information carefully for application procedures!!!

The M.O.R.G.A.N. Project is happy to announce that we have finalized our
2012 Small Grants Application program, criteria, and application procedures!

We have decided to focus our effort of this program to 2 areas:
1)  Adaptive bath/shower chair requests
2)  Support group/medical conference support

There are limitations to the program:
Specific make and model of bath/shower chair will be determined
by our Medical Advisory Committee, based on the individual answers
on the application and available funding.
Applicants will not be able to request a specific chair.

There is a $500 maximum award towards the costs of attending
a support group/medical conference.  The total amount approved will be
determined by our Medical Advisory Committee, based on availability of funding.
Applicants will be required to submit receipts for expenses.

ONLY OUR ONLINE APPLICATION WILL BE ACCEPTED.
We are unable to accept applications via mail, email or fax.

Please take a moment to read the following documents to familiarize yourself
with the minimum criteria requirements BEFORE filing an application!!


2012 Small Grants Application Package

Do you qualify?

… Application links will be available 5/20/12

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GRANT APPLICATION FORM - SUPPORT GROUP CONFERENCE

Section A

Applicant Information
*First Name
*Last Name
*Address 1
Address 2
*City   *State   *Zip Code
*Home Phone   Alternate Phone
Fax Number   *E-mail Address
*Relationship to Child

Child Information
*First Name
*Last Name
*Gender   
*Age   *Date of Birth Pick a date
Optional: Child's Picture
*Person(s) legally responsible for this child
 
Relationship to Child   Phone Number
*How many family members living in the home?
  Adults   Children
Children Ages
*Income (of the household)
*Is this Child covered by Insurance or Medicaid?
If yes, name of coverage   Policy #
Secondary Insurance or Medicaid   Policy #

Primary Physician Information
*Name
*Address 1
Address 2
*City   *State   *Zip Code
*Phone Number   *Fax Number
E-mail Address
*Child's Primary Medical Diagnosis
Child's Secondary Medical Diagnosis
*Has your child been diagnosed with Autism?
    
*Is Your Child Mobile?
*Description of Physical Disabilities

Section B

The M.O.R.G.A.N. Project can only approve up to a maximum of $500 per family to help off-set costs of attending Support Group/Conference expenses.
*Family Support Group Conference
*Dates of Conference
*Location of Conference: City, State
*Name/Title of Conference
*Have you attended this Conference before?

If so, when?
*Hosting Organization of Conference
*Contact Person for Hosting Organization
*Phone Contact for Hosting Organization
*Email Contact for Hosting Organization
*How many family members will be attending
*Adults
*Children
*Have you already registered for this conference?

*Have you applied for discounted/scholarship opportunities to reduce registration fees?

*Conference Registration Fees
*Estimated Travel Costs (total for all attending)
*Estimated Lodging Costs (total for all attending)
*Have you secured funding for this Conference from other/additional sources?

If so, can you provide documentation upon request?

*Will you be attending this conference if you are NOT approved for this small grant?

*Do you agree to submit expense receipts upon request?

If so, can documentation be provided upon request?

Other Funding
*Have all discount and/or scholarship opportunities offered by provider been applied for?
    
*Have you applied to other organizations already and been denied?
    
*How did you hear about The M.O.R.G.A.N. Project's Grants Program?
 
*Narrative
Please explain why you feel you would be a good candidate for this grant.

Forms & Releases

The following PDF downloads require Adobe Acrobat Reader

Adobe Acrobat Reader

*Medical Acknowledgement Form

Please download the following PDF file: Medical Acknowledgement Form. Then fill out the form offline, scan the signed copy, and upload the file via the file field provided.
 
*Conference Registration Confirmation Documentation upload

The following file field only allows a single file upload. If you have multiple files, please use a program to zip the files up together in one single file. Most versions of Windows or Mac OS X come with a built in ability to "archive" a number of files into a single compressed file.
 
*Grant Liability and Publicity Release upload

Please download the following PDF file: Grant Liability and Publicity Release. Then fill out the form offline, scan the signed copy, and upload the file via the file field provided.
 
Optional Supporting Document(s) upload

The following file field only allows a single file upload. If you have multiple files, please use a program to zip the files up together in one single file. Most versions of Windows or Mac OS X come with a built in ability to "archive" a number of files into a single compressed file.

 
 

GRANT APPLICATION FORM - BATH SHOWER

Section A

Applicant Information
*First Name
*Last Name
*Address 1
Address 2
*City   *State   *Zip Code
*Home Phone   Alternate Phone
Fax Number   *E-mail Address
*Relationship to Child

Child Information
*First Name
*Last Name
*Gender   
*Age   *Date of Birth Pick a date
*Height   *Weight
Optional: Child's Picture
*Person(s) legally responsible for this child
 
Relationship to Child   Phone Number
*How many family members living in the home?
  Adults   Children
Children Ages
*Income (of the household)
*Is this Child covered by Insurance or Medicaid?
If yes, name of coverage   Policy #
Secondary Insurance or Medicaid   Policy #

Primary Physician Information
*Name
*Address 1
Address 2
*City   *State   *Zip Code
*Phone Number   *Fax Number
E-mail Address
*Child's Primary Medical Diagnosis
Child's Secondary Medical Diagnosis
*Has your child been diagnosed with Autism?
    
*Is Your Child Mobile?
*Description of Physical Disabilities

Section B


*Goods or Services Requested - BathShowChair

*Estimated date goods/services required Pick a date
Brand/Make/Model/Color/Size Choice #1
Brand/Make/Model/Color/Size Choice #2
There is no guarantee that this specific make/model/color/size will be provided by The M.O.R.G.A.N. Project. We will make every reasonable effort to accommodate your preferences as funding and availability permit.

Other Funding
*Have all other sources for funding from insurance, Medicaid, Local, State and/or Federal programs been applied for?
    
*Have you applied to other organizations already and been denied?
    
*If so, can documentation be provided upon request?
*How did you hear about The M.O.R.G.A.N. Project's Grants Program?
 
*Narrative
Please explain why you feel you would be a good candidate for this grant.

Forms & Releases

The following PDF downloads require Adobe Acrobat Reader

Adobe Acrobat Reader

*Medical Acknowledgement Form

Please download the following PDF file: Medical Acknowledgement Form. Then fill out the form offline, scan the signed copy, and upload the file via the file field provided.
 
*Professional Recommendation Form

Please download the following PDF file: Professional Recommendation Form. Then fill out the form offline, scan the signed copy, and upload the file via the file field provided.
 
*Grant Liability and Publicity Release upload

Please download the following PDF file: Grant Liability and Publicity Release. Then fill out the form offline, scan the signed copy, and upload the file via the file field provided.
 
Optional Supporting Document(s) upload

The following file field only allows a single file upload. If you have multiple files, please use a program to zip the files up together in one single file. Most versions of Windows or Mac OS X come with a built in ability to "archive" a number of files into a single compressed file.