CUTE Connections Grant Request Application
Personal Information
Your Name
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First Name
Last Name
Email
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Have you previously applied for an SCN8A Family Meetup Grant?
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yes
no
unsure
To qualify for an SCN8A Family Meetup Grant, the event organizer must be a member of the SCN8A Families Support Group. Are you a member of the SCN8A Families Support Group? If you are unsure, please send an email to The Cute Syndrome Foundation at supportgroup@thecutesyndrome.com
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yes
no
unsure
Event Details
Proposed event date
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-
Month
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Day
Year
Date
Describe your proposed meetup. What activities and item will be offered (ex. food and beverages, paid speakers, kids' activities, parking vouchers, admission tickets, ect.). Tell us your plan to attract families to the event, any experience you have coordinating similar events, the need you see within the region or special group, and your plans to document the event.
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Estimated number of attendees
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Number of SCN8A patients represented
*
Proposed Budget
Please attach a proposed budget in US dollars for your proposed project. All budgets must also indicate where The Cute Syndrome Foundation funds will be used/allocated.
Proposed budget
*
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Estimated cost for the event.
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Amount requested for grant. Amounts greater than $1000 will be considered on a case-by-case basis.
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Questions or comments
Requests for an alternative or special arrangements
Use of funds. By checking below, you agree that: (1) The information in this application is true to the best of your knowledge. (2) Should the event be cancelled or the date changed, you are responsible to notify Shelley Frappier at shelley@thecutesyndrome.com. (3) You understand that unless otherwise specified, grants will be awarded as reimbursement of funds spent, after the completion of the event. Requests for special arrangements may be requested below.
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I agree
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