The ACFB Fund

ADHD or Autism Application

Please read this application carefully and respond to all of the required questions (marked with a *)

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What support are you looking for?
Location
Ethnicity
If this application is for a child (younger than 18) who is still living at home then please make this the household income.

For adult couples (18 or older) this is your household regular income from any source - salary, wages, WINZ, student allowance etc

For any other single adult (18 or older) this id your regular income from any source - salary, wages, WINZ, student allowance etc
Do you have a history of bi-polar or trauma
Click or drag files to this area to upload. You can upload up to 5 files.
You can do this as up to 5 images if you need. Please make sure it is your most recent statement. We are using this to validate your regular income

File Types accepted: jpg,gif,pdf,heic,png,webp,jpeg
Click or drag files to this area to upload. You can upload up to 2 files.
You can do this as up to 2 images if you need.

File Types accepted: jpg,gif,pdf,heic,png,webp,jpeg
Click or drag files to this area to upload. You can upload up to 3 files.
You can do this as up to 3 images if you need.
File Types accepted: jpg,gif,pdf,heic,png,webp,jpeg
In submitting this application I understand/agree with the following :

* That my information and application will be viewed within the ACFB Fund Clinical Team to determine my eligibility.
* I have provided documentation of ALL income sources and understand that if I am dishonest about my true income, I may not be accepted into the program.
* I consent to my information being viewed for the purposes of auditing my application.
* I also understand that The ACFB Fund will keep confidential records on the statistics around how my application/funding is used and may reach out for this purpose.
* If accepted into the program, I agree to participate in collecting feedback on the program with the aim of gaining additional funding.

If you are unsure about any of these, please email info@acfbfund.org.nz with your questions before submitting this application
Agreement