2024-2025 Florida Autism License Plate Grant Recipient Questionnaire

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Organization Name: *

Primary Contact Name & Title: *

Email *

Phone *

About Your Funded Program

What is the name of the program funded by this grant? *

Briefly describe the program’s purpose and activities. (2-3 sentences) *

How many individuals with autism are benefiting from this funding? *

What specific impact has this grant had on your program and its participants? (e.g., new services, expanded reach, enhanced resources) *

Are you on track to meet the outcome and budget as submitted with the application? *

If not, what are the reasons for any variances?

Please attach the Year to Date Budget to Actual Numbers

Drag & Drop Files, Choose Files to Upload You can upload up to 5 files.

In what city is your organization based? *

What city/county does your program primarily serve? *

Does your program have a statewide impact or serve multiple regions? (copy) *

If yes, please list the counties or regions covered:

Do you have a success story or testimonial from a participant that illustrates your program’s impact? (Please share a brief example.)

Are there any compelling visuals (photos, videos) that showcase your program in action? *

File Upload

Drag & Drop Files, Choose Files to Upload You can upload up to 5 files.

If Yes, please upload example photo or video we can share on social media or with news media.

What is one key message you would like the public to know about your program as it relates to its support of the autism community? *

Would a representative from your organization be available for a media interview in April? *

Do you have upcoming events in April related to autism awareness that we should know about? *

share serve variances?

If yes, please provide details: