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Grant Application

Before completing this grant application form. Please review the eligibility and documentation requirements on the Remainder Fund Grant Program page.

Remainder Fund Grant Application
Please enter the dollar amount being requested.

APPLICANT INFORMATION

The applicant is the person with a disability for whom the grant is being requested. If you are completing the application on behalf of that person, you will enter your contact information in the last section of the application form.
First
Last
Address
City
State/Province
Zip/Postal
Membership in The Arc is not a requirement to receive grant funds.
Each grant type has specific documentation requirements. Your grant request may be denied if appropriate documentation is not submitted along with this application. For details on what documentation is required, visit the Grant Program page. You may upload up to 5 documents.

Maximum file size: 10MB

How would you like us to disburse the grant award funds?

PAYEE INFORMATION

Grant awards will only be paid directly to a vendor or service provider. Provide payee information for grant fund disbursement.
Payment can NOT be made payable to the trust beneficiary or family member.
Name
Address
City
State/Province
Zip/Postal
Country

ONLINE PURCHASE INFORMATION

Copy and paste the website URL that you would like us to use to complete the purchase.
At which store would you like to pick up your items?
Shipping Address
City
State/Province
Zip/Postal
Country

Items to Purchase

Please enter information on the items you would like to purchase. You may add additional items (up to 10 total items) by clicking the Add Item button.
(include item stock number, size, color, etc)
plus1 Add Item minus1 Remove Item

REQUESTOR INFORMATION

First
Last