Individual Differences :: Springfield, IL: Get Help

Get Help

To access our Financial Assistance Program, simply complete the form below or send us an e-mail at info@individualdifferencesinc.org.

Financial Assistance Form

Referral by:

Applicant's Name:

Date of Birth:

E-mail Address

Address

Phone Number:

City:

State:

Zip Code:

How did you hear about Individual Differences?

Tell us your story:

Are you currently working?

Items Needed (Specify equipments/services):

Would you be willing to volunteer at one of our fundraisers?

Spam Prevention:*