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

CONSUMER GRANT APPLICATION

Return to:
AZ AER Scholarship Project 
c/o Rajiv K. Panikkar
8157 N. Torrey Pl.
Tucson, AZ, 85743
oandmguy@comcast.net and rpanikkar@asdb.state.az.us


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 
Deadline: Application must be received two (2) months prior to event or activity or date needed.
Applicants will be notified one (1) month after application has been received.
Updated 2-19-10-RKP