top of page

This form is for Ausome Parents/Caregivers to request help on various items that they need help with. This can include bills, devices, and other items that are not included by insurance. Our organization will pay for and purchase items directly to/from the source. PLEASE NOTE: We will NOT send cash/payments directly to applicants.

Please fill out ALL Information and attach all required documents in order for your application to be considered. You WILL not be contacted for additional information. If anything is missed, an entirely new application must be submitted for consideration.

Once your application is approved, you will be contacted via email AND text message verifying your approval. If you have any questions about your application status, please email
Please allow between 6-8 weeks for application processing.

Support Group Session
Coming Soon.JPG
bottom of page