Completed applications can be sent to:

Ashley@TeamJosiah2K22Foundation.com or mail completed application in to:

Team Josiah 2K22 Foundation
c/o Ashley D. Bates
715 Main Street, Quinter, Kansas, 67752

Download the physical application here, or fill out the digital application below. If you are having any problems downloading or filling out the application, please email Ashley@TeamJosiah2K22Foundation.com

Click here to download application (PDF):

Parent's Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Child's Information

Phone Number

Email Address

Child's Name

First Name

Last Name

Child's Birthday

(MM/DD/YYYY)

Child's Age

Diagnosis Date

YYYY

More Information on Observation

What are the childs needs

What are the childs strengths

What are your concerns

Who referred you?

Include all contact info of referral

Prior Services Received?

Physician (Pediatrician)

Home Team (ABA)

Family Gross Income

Reason for need of grant.

Resources:

Families Together Inc.-

http://familiestogetherinc.org/

KCART-

http://kcart.ku.edu/

Autism Speaks-

https://www.autismspeaks.org/families-adults

https://www.autismspeaks.org/family-services/tool-kits

TASN-

http://kansasasd.com/

Herndon Speech-Language-Hearing Clinic at Fort Hays State University

https://www.fhsu.edu/herndon-clinic

Northwest Kansas Educational Service Center
www.nkesc.org

Puzzle Piece Ranch Autism Southwest Kansas
www.puzzlepieceranchask.com

Autism Hope for Families
Chanute, Ks 66720
autismmom2011@yahoo.com
Phil & Nikki Jacobs

Autism Resources for Families

http://www.nationalautismcenter.org/resources/for-families/

Sesame Street Autism Resources for Parents

http://autism.sesamestreet.org/

Reduce the Noise: Help Loved Ones with Sensory Overload Enjoy Shopping

http://www.retailmenot.com/blog/sensory-overload-while-shopping.html

CDC Autism Links and Resources

http://www.cdc.gov/ncbddd/autism/links.html

Operation Autism for Military Families

http://www.operationautismonline.org/

Academic Accommodation Resources

http://www.washington.edu/doit/accommodation-resources-autism-spectrum-disordersasperger-syndrome

Home Modifications for Autistic Kids

http://www.homecity.com/creating-a-home-where-your-child-can-thrive-with-a-disability#Autistic

Temple Grandin's Teaching Tips

https://www.iidc.indiana.edu/?pageId=601

Estate Planning for Parents of Kids with Autism

https://www.justgreatlawyers.com/estate-planning-for-parents-of-children-with-autism

Team Josiah 2K22 Foundation is a 501c3 public charity