REACT AAC Scholarship Application

Research & Education for Autistic Children's Treatment AAC Scholarship Application

Empowering Voices, Unlocking Potential: R.E.A.C.T., Inc. is excited to offer this scholarship to support individuals with AAC/Communication needs seeking appropriate interventions that may cause families undue financial challenges. We believe communication should be accessible, no matter what race/creed, religion, or social/economic status, and it is R.E.A.C.T.'s goal to help individuals and families who need extra support in reaching their full communication potential. Each 2025 R.E.A.C.T., Inc. scholarship is valued at $2500. If you are granted a scholarship, you will be emailed a packet that includes acceptance paperwork for both you and your therapy provider. Both parties will need to agree, sign, and return the R.E.A.C.T. paperwork. Scholarship payouts are sent directly to therapy providers for services rendered. If you have questions or need to reach us, you may contact us at secretary@REACTforHope.org. This is an application. Scholarship grants are not guaranteed by filling out this form.

Name(Required)

First Last

Date of Birth(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Email(Required)

Is the applicant a citizen of the United States?(Required)

Representative

The person assisting in filling out the application(Required)

First Last

The relationship to Applicant that is assisting in filling out this application(Required)

Are you the legal gaurdian of Applicant(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Email(Required)

Who referred you to apply for REACT Inc.'s Scholarship Program?

Therapy Provider

Provider Name(Required)

Company(Required)

Provider Address(Required)

Street Address Address Line 2 City State ZIP Code

Provider Phone(Required)

Provider Email(Required)

REACT has permission to contact this provider regarding the applicant’s treatment needs.(Required)

I Agree

Applicant’s provider informed you of your HIIPA Rights and you agree to allow the listed provider release the applicant’s AAC treatment plan and progress to R.E.A.C.T. and it's internal affiliates.(Required)

I agree

Income

Total Annual Household Income(Required)

Testimony of Need

Please share your need for treatment(Required)

Please share your need for financial assistance(Required)

Goals and Objectives

Please share your goals, objectives, and expectations for Stencil-Board AAC Treatment including your time commitment to this therapy(Required)

Have you already started Stencil-Board AAC Treatment(Required)

Date treatment started / Date you hope to begin therapy(Required)

If granted a scholarship, would you be willing to share treatment updates and outcomes with REACT?(Required)

You are not required to share treatment updates to be granted a scholarship.

Part of the application process is a recorded virtual interview. If you are chosen to be awarded a scholarship, would you be willing to share parts of your video interview story with the public?(Required)

We find personal testimonials are a wonderful way to raise awareness and help the public better understand how REACT is making a difference in the lives of others. You are not required to share your personal testimonies with the public to be granted a scholarship, but we hope that you would consider it.

I have reviewed my responses in this appplication and attest that my answers are true and accurate.(Required)

I attest the above is true and accurate

Signature