Grant Application

Do you have proof that you are a resident of Lancaster County?
Do you have and would you be able to provide proof of an Intellectual Disability by a medical professional?

Full Form

Person Needing Assistance
Person Completing this Form
Your Address
Assistance Requested
Services Received
Amount Requested
Will this be a grant or a loan?
How would you like to receive the payment?
(Checks payable only to place of purchase, and cannot be made out to individuals)
Address to send the payment/Visa Gift Card?
All requests are reviewed electronically on an as needed basis. Please give a timeline when making vacation requests. Please note that all approved requests sundown six months after they are approved unless otherwise stated. The Foundation Policies and Procedures are also available upon request. 

For additional information please go to the contact portion of the  homepage to contact the foundation.

All information obtained from this form will only be used for Quality of Life Foundation grant purposes.