Pathway for Hope Application

Name of person request is for: * (an asterisk indicates required fields) *
Name of person request is for: * (an asterisk indicates required fields)
Name of person making request *
Name of person making request
Address of person making request *
Address of person making request
Is the person the request is for currently receiving Intellectual Disability Services or other services from any provider other than SLI? *
One purpose of the Pathway for Hope Fund is to create interest with community members to help provide financial support as well as to become more familiar with the needs of people with intellectual disabilities. Do you think the request is something that would receive financial support from members of the community? *
Are you willing to be on television and/or radio to help tell your story in order for us to garner community support and financial assistance with the item requested? *
Are you willing to allow us to tell your story on your behalf? (one of the two is required in order to receive consideration for funding). *
Reference #1 *
Reference #1
List first reference who can attest to the need for the request and the lack of funds available to support the request outside of the Pathway for Hope fund:
Reference #1 Address *
Reference #1 Address
Reference #2 *
Reference #2
List second reference who can attest to the need for the request and the lack of funds available to support the request outside of the Pathway for Hope fund:
Reference #2 Address *
Reference #2 Address