Bursary Support Online Application – Down Syndrome Association of Hamilton

READ BEFORE SUBMITTING:

Use this form to apply for DSAH Therapy or Recreation/Technology Bursary. Once submitted it can take up to 8 weeks to receive your reimbursement by e-transfer. Requests submitted at the end of the fiscal year may take longer to process due to high volumes. Help us expedite your request by submitting multiple requests at one time if possible. This form can take up to 16 invoices.

Applicant Info

The applicant is the individual to be reimbursed for the bursary.

Applicant Name *

First

Last

Who is using the bursary? *

The name of the person that is benefitting from the bursary.

My annual membership is up to date *

Only members with active memberships can apply for bursaries.

Have you applied for a bursary this fiscal year?

Yes
No
Not sure

The fiscal year is April to March of the following year (i.e. April 2022 to March 2023)

Email *

The address to which the e-transfer will be sent.

Phone *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Bursary Request Information

Bursary Type *

Therapy (up to $750)
Recreation (up to $500)
Volunteer Promo (up to $500)

*Volunteer Promo = members can volunteer 10 hours and earn up to $500 additional bursary for VIP in their household. Offer expires May 2024.

Program / Service Provider Information *

Include details such as name of service provider, description of service, date of service and payment date

Please upload copies of your receipt(s) / invoice(s) *

Click or drag files to this area to upload. You can upload up to 16 files.

Photos, Scanned Documents, PDF’s are accepted.

Amount to be Reimbursed *

The total amount of all invoices.

Signature *

By submitting this application form you confirm that, where possible, funding for services through private insurance was exhausted before accessing the DSAH bursary.