FINANCIAL AID APPLICATION
As part of its mission, the Fred J. Wellington Foundation supports families in need of financial assistance, helping them to receive research-based treatment for dyslexia at approved treatment centers. Please complete the following application and return to our offices. Applications are reviewed on a quarterly basis, and notifications will be given quarterly as well: January 1, April 1, July 1 and October 1.
Contact Information
Name of Applicant: _______________________________________ Date of Birth_______________
Parent(s) Name(s): __________________________________________________________________
Home address: ______________________________________________________________________
City, State and Zip: __________________________________________________________________
Daytime Phone:____________________________ Mobile Phone: __________________________
Email Address: ______________________________________________________________________
Financial Information
Combined 2013 Family Annual Income: $_______________________
Combined Total Liquefiable Funds (includes Savings and Trusts): $_______________________
Number of Dependents Living at Home: _______________________
Has the applicant been tested for language deficiencies? (circle) Yes No
If yes, please list conditions and including dates and treatments: ___________________________
_____________________________________________________________________________________
Select preferred treatment center: (circle one) Wellington-Alexander Center
The Morris Center
I acknowledge that all the information provided above is true.
________________________________________ _____________________________
Signature of Applicant (or Guardian) Date
Please send to: Fred J. Wellington Foundation, 9821 E. Bell Road, Suite 100, Scottsdale, AZ 85260
Fred J. Wellington Foundation ©