Direct Help Grant Application

(If Different From Mailing Address)

Note: Please be very specific with your description of monetary help or items needed for your child (make, model, color, etc.). At no time will money be awarded directly to families. All grant offerings are paid directly to the vendor and/or service provider. This may include tuition for specific classes, medical evaluations, learning materials, testing, therapies, etc. If you are interested in additional items to total the allowed grant amount of $500, please email additional items, cost, service provider, vendor, or website/link to buy items to grants@carlosvieirafoundation.org. A recommendation letter is not required for any items that can be found on or are similar to those found on our approved websites: arktherapeutic.com, autism-products.com, funandfunction.com, pecsusa.com, and nationalautismresources.com *Note: iPads, electronic devices, computers/laptops cannot be granted two years in a row. We cannot order items from Costco as it requires a membership.

Email is the preferred/quickest option when processing grants.

List of names of those that helped complete this application

Please Note: This next section is optional and not required to be filled out in order to qualify for the Carlos Vieira Foundation Direct Help Grant. However, it is essential information needed by the Carlos Vieira Foundation when applying for funding which will allow us to assist more families.

All legal parents or guardians must sign below.

Liability Disclaimer: I hereby release, indemnify and hold harmless The Carlos Vieira Foundation for any injury or accident that may occur, and I will assume all liability in connection with an injury (including any injury caused by negligence) that may occur with any of the awarded items associated with this Direct Grant program. By signing below, I understand and agree to these conditions.