Please provide us with the following information so we can review your service request.

All information you enter here is kept strictly confidential and will only be reviewed by the board of Autism Radio.

Some pre-qualifying information to be aware of before filling out the application:

• A double income family's gross income shouldn't exceed $70,000 per year. 

• A single income family's gross income shouldn't exceed  $40,000 per year.

• A 2-year waiting period is imposed before re-applying for additional services given.

Note: We also require a letter from a doctor for your child's diagnoses and a copy of last year's full Tax Return.

You must send us your complete tax return either to or via regular mail.

If we require any additional information, we will contact you.

NOTE: Filling out this form does not guarantee services request will be fulfilled.

Copyright © 2016, Autism Radio™ and Hope Saves the Day®. All rights reserved. Please see all website disclaimers on our About Us page.