Scholarship Program

The scholarship application is to be filled out by a parent or legal guardian, and will be used by MAP to determine eligibility for assistance. The information provided in this application will remain confidential and will be reviewed only by a Board Member of MAP.  All application fields must be completed so that eligibility can be accurately determined. Please contact us with any questions or to request a paper copy of the application.

  • Parent Financial Information

  • PLEASE NOTE:

    A copy of the parents’ or guardians’ current Michigan 1040MI Tax form and/or W-2 wage statement must accompany this request for assistance. The IRS requires that we follow proper procedure and obtain this documentation in order to ascertain need.
  • Accepted file types: jpg, gif, png, pdf.
  • HOLD HARMLESS CLAUSE

  • I, [First Name Last Name] as the parent or legal guardian of the above-named child, understand that the persons rendering services, professional and otherwise, are independent of and not employees or agents of the Michigan Autism Partnership nor are they in any manner under its direction or control.

    As the parent and or legal guardian, I do agree to hold the Michigan Autism Partnership harmless from any claim for or on behalf of myself or the child for any damages, whether from physical injury or otherwise, arising out of the transportation to and from, if provided, any examination, treatment, consultation or program, or during the course of any examination, treatment, consultation or program, in which the above-named child participates.

    All the above information is a correct.
  • This field is for validation purposes and should be left unchanged.