Jean Wolff-Rossi Fund for Participant Involvement (Rossi Fund) Application Form
(ONLY ONE NAME PER APPLICATION.)
An application must be received by NCCDD 15 days prior to the first day of an in-state event and 30 days prior to first date of an out-of-state event. Applications are funded on a first-come, first-served basis. The NCCDD reviews applications frequently, and the decisions on all applications will be mailed in writing to all applicants.
If you need assistance completing this application, please contact 1-800-357-6916.
Customer Information
Disability Connection (required):
To meet the criteria for receiving funds from the Jean Wolff-Rossi Fund for Participant Involvement it is essential that the following information is completed. (Incomplete applications may be returned to applicants for completion.)
Ethnic Status (optional)
Event You Plan to Attend and Seek Financial Assistance (required):
Website address about this event (if available):
Statement of Purpose (required):
In the space provided below, please write a brief statement explaining your goals related to this particular event.
1. What is it you hope to learn/achieve by attending?(*)
2. What will you do with the information you receive at this event?(*)
3. How will you share the information with others in your community?(*)
Financial Assistance is Needed For (required):
The Jean Wolff-Rossi Fund for Participant Involvement (Rossi Fund) can only partially fund the cost of attending an event. Rossi Funds are available to reimburse individuals for the types of expenses listed below (individuals may apply for funds to cover up to 3 of these expense categories).
Please indicate the amount of funds you are requesting – You may apply for funds from up to 3 of the expense categories listed below. There is a limit of $1,000 per year, per person, for in-state events and up to $1,200 per year, per person, for out-of-state events. Regardless of how many people apply, the maximum amount available for any single activity or event cannot exceed $3,000 in-state and $3,600 out-of state. An individual may only receive one Rossi Fund award in a 12-month period.
I have read and meet the criteria of the guidelines, meet the definition of developmental disability given, and completed this application with all information requested. I have also enclosed the official brochure with event description, agenda/schedule and registration form or the same information copied from the official event web page/site.
SUBMIT FORM (form will clear with each submission)
DISCLAIMER: The Jean Wolff-Rossi Fund for Participant Involvement (Rossi Fund) is not an entitlement. NCCDD reserves the right to use discretionary judgment on any application they deem appropriate. Funds will be distributed consistent with the Council’s mandate in Federal Law for commitment to systems change, advocacy, and capacity building.
*Incomplete applications may be returned to applicants for completion.
**DO NOT SUBMIT WITHOUT PROVIDING WEB PAGE/SITE LINK TO THE OFFICIAL EVENT SITE WHICH SUPPORTS ACCESS TO EVENT DESCRIPTION, AGENDA/SCHEDULE, AND REGISTRATION FORM.**.
Proof of submission: You will receive a return e-mail to confirm your submission. If you have not heard from the Rossi Fund in three days, please give us a call.
US MAIL: EMAIL: [email protected] FAX: 984.920.8201PHONE: 984.920.8200, (Toll Free Voice/TDD) 800.357.6916
