Nominate

Nominate for a Lapse Grant or Guidance.

I Am Applying For Myself or A Child

✓ No income verification required
✓ No lengthy paperwork
✓ Reviewed within 48–72 hours
✓ Funds sent directly to your provider

I Am a Therapist, Provider, or Advocate

✓ Therapists, BCBAs, SLPs, OTs, PTs welcome
✓ Teachers, case managers, and social workers
✓ Family consent confirmed during review
✓ Become a provider partner for faster processing

Nomination Form

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Thank you for your response. ✨

I Want to Nominate (Name)

Form Completed by (Name)

If self-applying, please enter N/A.

Who is Completing the Form

Age Range of Recipient(required)

0-17 18+

Phone

State

County

Are you on Medicaid?

I am looking for support with…

How did you hear about us?

What Happens Next

We will reach out in 2-3 days to schedule an intake call.

Have a question first?

We respond to every message, you can always email us if you have questions before applying.

Email Us

Grant awards are subject to available funding. Submission of an application does not guarantee assistance. Applications may be placed on a waiting list until sufficient funds become available.

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