Matt Cohen Membership Support Fund Eligibility Requirements and Application Form

CHADD offers two one-year, individual/family memberships per year to those who otherwise cannot afford membership dues. These funds are based on financial need, and are processed through the Matt Cohen Membership Support Fund. A one-year membership is made available to those who qualify.

When CHADD has membership funds available and an application is accepted, the applicant is notified promptly and added to the CHADD membership database. If such funds are unavailable, applicants are placed on a waiting list. Membership funds are provided through designated contributions to CHADD.

To apply complete this application form (fields marked with an * are required)

First Name:*  
Last Name:*  
Day Phone Number:*  
Address:*  
City:*  
State/Province:*  
ZIP/Postal Code:*  
Email Address:*    
I am a current member of CHADD.
I have previously received a free membership from CHADD.
I would like to be affiliated with the chapter in my area.
Financial Need: Please tell us briefly about your financial circumstances and need for CHADD programs and services: