The Jason Cunningham Financial Aid Award.pdf


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Check all the service(s) below that best describe what your child is receiving or will receive in the coming
year and complete the information to the right of each selection.
2018 – 2019 Total Amount Paid by Family
Auditory/Speech-Language Services
$_________________
Specialized Preschool Program – Katherine Hamm
$__________________
Private Preschool
$__________________
Parent/Family Training
$__________________
Hearing Aids Purchase
$__________________
Hearing Aid Maintenance
$__________________
Cochlear Implant Initial procedure / programming
$__________________
Other Auditory Devices such as FM Systems, Assistive
Listening Devices, etc.
$__________________
Transportation Costs
$__________________
Other - Physical Therapy, Occupational Therapy, Genetic testing,
Out of pocket medical expenses
(please describe):
$__________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Total number of dependents in your household, including the applicant: __________________________
Does the applicant receive support from Medicaid or SSI? _______________________________________
Please check your total combined annual gross household range of income: