SCHOLARSHIP APPLICATION

Name: June Teen Neurodiverse Connections Group - Body Movement for Health
Start: 2026-06-26T17:30:00-07:00
End: 2026-06-26T19:00:00-07:00
Location: Location is TBD

We are happy that you have chosen to apply for a full or partial scholarship to attend our event!

We feel that no barrier should come between sharing the important information and experience that is this important information.

Please answer the following questions. Shortly following your submission, the Lewis County Autism Coalition will reach out to you

to discuss next steps.

Can't wait to meet you!

First name

Last name

Street Address (or) P.O. Box

City, State

Zip Code

Phone

Yes, subscribe me to your newsletter.

What is the name of the event you seek a scholarship for?

INTEREST IN THE EVENT: Why are you interested in participating? Please share about your family, your child's age(s), needs (Diagnosis if any, behaviors, challenges, concerns), or anything else you feel is important for us to know.

FINANCIAL NEED: Please describe your financial need for this scholarship?(Please limit your response to 150 words.)

Are you requesting a FULL or PARTIAL Scholarship? If you are able to contribute any portion of the admission cost, please include the dollar amount below.

Do you require any special accommodations (i.e., translator, seating, other) If no, write N/A. If yes, please describe.

June Teen Neurodiverse Connections Group - Body Movement for Health

Fri, Jun 26

Location is TBD

Save the date...more details about this month's activity regarding body movement coming soon.

June Teen Neurodiverse Connections Group - Body Movement for Health

Time & Location

Jun 26, 2026, 5:30 PM – 7:00 PM

Location is TBD

About the Event

Parents/guardians need to sign a waiver www.lcautism.org/teenwaiver (attached—print and bring it, or grab one there if you can’t print). No stress, just show up!

Save the date...more details about this month's activity regarding collaboration coming soon.

Please RSVP early to save your spot and get the latest info on where we’ll be and what’s happening.

Parent/Guardian Note: For some events, a signed waiver may be required.

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SCHOLARSHIP APPLICATION

June Teen Neurodiverse Connections Group - Body Movement for Health

Time & Location

About the Event

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