ASSOCIATION FOR EDUCATION & REHABILITATION 
OF THE BLIND & VISUALLY IMPAIRED
~ ARIZONA CHAPTER ~

CONSUMER GRANT APPLICATION

Return to:
Holly M. Lawson
1103 W Huron St. 
Tucson, AZ 85745
hollyml@email.arizona.edu


Applicant's Name: 

AZ AER Sponsor’s Name: 

Address: 


Phone: 

E-mail: 

Amount of Money Requested:	

Date Needed: 

Money is requested for (Please give a complete outline of the use for the money and the benefit):




I agree to use Consumer Grant funds solely for the purpose as described above. I understand that any unused funds must be returned to the Arizona Chapter of AER. I agree to write an article for AERizona View or present at a meeting of the general membership of Arizona AER.

Signature____________________________ 	Date __________________



For AER Use: Date Received:         	Approved 	         Disapproved 
(If grant application is not approved, a written explanation must be sent to the applicant with 30 days of receipt of application).	

Date check issued:

        AERizona View written follow-up        	 AZ AER Conference presentation