Autism Support Fund Application and Instructions

To request ASF funding, please complete the application form below.

Age of the recipient must be between 2 and 21 years old.

Recipient’s diagnosis must be an autism spectrum disorder (ASD). Please provide documentation from a licensed psychologist or behavioral health professional who has completed a comprehensive evaluation.

Services/programs/equipment you are applying for must be directly related to the recipient’s autism spectrum disorder. Funds requested should assist the recipient’s treatment plan/growth/development or promote the recipient’s independence or life skills. Examples: Tools/equipment specific for ASD; social skills classes, learning devices, etc. When requesting funding for treatment/services, the service must be evidence-based.

You may submit one (1) application per quarter for a maximum of $1,000 per year in Walworth County and $500 per year in Rock County. Checks will be written to the vendor.

Applications must be submitted via this electronic form and will only be considered if the application is fully completed.

Grants are only accepted quarterly:

  • January 1 – 31; 1st quarter
  • April 1 – 30; 2nd quarter
  • July 1 – 31, 3rd quarter
  • October 1 – 31, 4th quarter

Autism Support Fund Grant Application

  • MM slash DD slash YYYY
  • *See instructions in details
  • Max. file size: 1,000 MB.
  • Max. file size: 1,000 MB.
    Documentation may include supportive reports from others who can attest to the value of the request for this individual, photos of item or service requested, information about details of the item/service/cost, etc.
  • Max. file size: 1,000 MB.
    Copies of the most recent income information for each adult in the household including pay stubs, Social Security, unemployment, retirement, pensions, etc.


(608) 755-8821


(815) 971-4141