Please share your reasons for applying for financial aid (if needed, us additional paper):
All information submitted to AHA shall remain confidential. Please note that, pursuant to federal law requirements, AHA reserves the right to follow up to ensure any approved grant was actually used for its intended purpose.
I certify that the information on this form is true and complete to the best of my knowledge.
I understand that if I receive this financial aid and will use it exclusively for my child with a diagnosis of Autism.
By my signature (or e-signature) below, I hereby declare the above statements are true and correct to the best of my knowledge. I have clear and convincing documentation of all above statements and can provide these documents upon request of the AHA Financial aid Program. My signature below also confirms that I understand the eligibility and requirements of this scholarship and it will be reviewed on a yearly basis.