Direct Help Grant Application

Thank you for participating in our Direct Help Program. Our mission is to provide services, medical necessities, and educational tools to families who live in Central California that are affected by Autism. Please fill out this application in its entirety before submitting.

Privacy Statement:

The information included in this application will remain private and confidential and is used for Foundation use only.

Child with Autism (if requesting aid for more than one child, please fill out a separate application):

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Child With Autism

Mother/Legal Guardian

Father/Legal Guardian

Shipping Address (If Different From Mailing Address)

Dependent Children Information (Other Than Child Applying for Grant)

Doctor(s) Involved In Child's Diagnosis and/or Treatment

Requested Items to be Purchased by Foundation if Grant is Awarded

Previous Grants

Future Correspondence
Email is the preferred/quickest option when processing grants.

Electronic Device Form (Only Fill This Out if You Are Requesting an Electronic Device)
Information for this form can be gathered from the child’s parents, teacher, AT specialist, physician, or any other professional that can explain how this electronic device will directly help with the child’s autism. Please fill out this application in its entirety and remember to print clearly as illegible applications cannot be considered.

Note: This device is to be used solely to help the individual with autism named on the application and not for family members to use for personal reasons.

Name of People who helped to complete these questions:

Demographic Questionnaire
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.

Necessary File Uploads

Signatures
All legal parents or guardians must sign below.


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We are always looking for amazing people to join our organization and volunteer their time.  From events all over to simple fundraisers, we always have a need for more volunteers.