NASA assistance

Insurance premium & transportation help

This is the form for the two things Nevada Autism Support Alliance funds directly: the insurance premium program and travel or gas costs. It takes about two minutes, and you do not need a diagnosis, paperwork, or an account to ask.

Looking for the state programs instead? ATAP, Desert Regional Center and Katie Beckett are filed in a different place — we fill the real state forms for you there.

Go to the state application portal

About you

First name *

Last name *

Your relationship to the child *

Your gender

Phone number *

Email *

Best way to reach you

About your child

Child's first name *

Child's last name *

Date of birth *

Child's gender

Has your child been diagnosed with autism? *

A "no" or a "not sure" is completely fine — we help families at every stage, including before a diagnosis.

Insurance

What insurance does your child have?

Household

We ask because most of these programs measure need against household size, and because it tells us which ones you are likely to qualify for before we call. Approximate is fine, and you can leave it blank.

People living in your home

Children or dependents

Total monthly household income before taxes

What are you asking us for?

Check either or both. You are not committing to anything, and we will talk it through with you.

Insurance premium help — shorter waits, more providersGetting your child seen sooner, by more of the providers you actually want.Travel and gas assistanceHelp with the cost of getting to appointments.

Anything else you need (optional)

What's going on for your family

Tell us in your own words

Optional, and there is no wrong way to write it. This is the part that helps us most — it is read by a person, not scored by anything.

Before you send this

·Nevada Autism Support Alliance is a Nevada 501(c)(3) non-profit.
·Every request is reviewed case by case, and submitting this form does not guarantee that any assistance will be provided.
·Assistance may be changed, paused, or ended at any time.
·Where we help with an application to a state agency, I remain responsible for that application. We help prepare and file it, but we do not control and are not responsible for the agency’s decision, its timing, or its outcome.
·We are not a healthcare provider and do not provide medical, legal, or tax advice.

How we handle your information is set out in our Privacy Policy and HIPAA notice.

I have read and understand the points above, and the information I have given is accurate to the best of my knowledge. *Nevada Autism Support Alliance may contact me about this request by phone, text message, and email. Message and data rates may apply. I can stop messages at any time by replying STOP to a text, or by asking us to stop. *

Free. No account needed. A real person reads every one of these.