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2. Homer Township Highway Commissioner Special Needs Grant
4. First Name
5. Last Name
7. Address1
9. City
10. State
11. Zip
13. Email Address
14. Phone Number
16. Date of Birth
    Date of Birth
17. Place of Employment (if applicable)
19. Essay about Candidate

    Answer the questions below (maximum 500 words) in the space provided.

    1. Explain nominee's specific learning disability, how it has challenged them, and specific strategies they have used to cope. 
    2. Discuss nominee's accomplishments (i.e. extra-curricular activities, community service, and work accomplishments). 
    3. What career does the nominee hope to pursue? 
    4. How would this grant benefit the nominee, and why do you think they should be selected to receive it?
21. Type your essay response below.
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23. 1. Receive an email copy of this form.
24. Email address

    This field is not part of the form submission.

25. Submit

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