Scholarship - Reapply

For those reapplying for scholarships, please use this form.

Link to Income Table for last question

If your email has changed, enter the new email here, and be sure to enter your Beneficiary ID in the next field.

Facilitator Name

If someone other than the applicant is assisting in completing this form, please enter their name here. Otherwise, leave blank

Beneficiary ID

Please enter your Beneficiary ID. This will have been assigned to you the first time you applied. NOTE: This is NOT your award number. To get your Beneficiary ID, go to specialneedsrespite.org/status and enter your email address.

Parent First Name

Parent Last Name

Mobile Phone

Alternate Phone

Child First Name

Child Last Name

Child's Age

Date of last scholarship award

City

Zipcode

Were you able to use all the funds from your previous scholarship?

YesNo

Do you have other funding such as GCSS, NOW/COMP Waiver, or DBHDD? Check all that might apply

If you have not yet applied for any waiver, please tell us why

If there are any changes since you last applied, please list these here. This would include name, phone, address, or anything about your situation that would need updating

What have you done to help keep our scholarship fund growing?

Screenshot

Drag your files here

Additional screenshot

Drag your files here

How has Special Needs Respite helped you and given you hope?

Please describe how SNR has helped you. For example, if the funds enabled you to recharge, or spend time with a spouse, etc. Be as specific as you'd like. We want to hear from you! If you'd like to make a video testimonial, we would love that - just visit https://tinyurl.com/4kyuffev

How was the application process?

Please describe the application process. Was it easy? Confusing? Let us know so we can improve our process.

If you have feedback from your caregiver on the invoice process, please share it here.

Community Reinvestment Act Information

Check all that apply. This information helps us gather statistics under Georgia’s Families of Children with Special Needs Reinvestment Act program, helping us help more families! For income table, see this link: https://dch.georgia.gov/document/document/2025-federal-poverty-guidelines