About Us
Scholarships
FAQs
Contact Us
News

About Us
Scholarships
FAQs
Contact Us
News

APPLICATION PROCESS

Scholarship Application

We understand the challenges families face when navigating feeding therapy. The BITE Foundation offers financial assistance to ensure every child has access to the life-changing care they deserve.

1. Family / Caregiver Information

Parent/Guardian Name(s)

Child's Full Name

Child’s Date of Birth

Email Address

Address

Phone Number

Preferred method of communication

2. Child Background Information

Please describe your child’s feeding challenges.

Has your child received any diagnosis? If yes, please list:

ARFID Pediatric Feeding Disorder Autism Spectrum Disorder Attention Deficit Hyperactivity Disorder Oral motor delays Sensory processing challenges Other

Other

How long has your child been experiencing feeding difficulties

What foods/drinks does your child currently accept?

Are there any medical concerns related to feeding?

Has your child previously received feeding therapy?

Yes No

Type of therapy

Length of treatment

Current provider (optional)

3. Requested Services / Financial Need

What services are you requesting scholarship assistance for?

Evaluation Inpatient feeding therapy Outpatient feeding therapy Other

Other

Estimated cost of services

Does your insurance cover any portion of treatment?

Have you been denied coverage for feeding therapy?

What financial barriers are preventing access to care?

Are there additional expenses related to your child’s feeding needs?

4. Household Financial Information

Total annual household income:

Under $25,000 $25,000–$50,000 $50,000–$75,000 $75,000–$100,000 Over $100,000

Number of people in household

Number of dependents

Is anyone in the household currently unemployed?

Does your family currently receive:

Medicaid SNAP SSI Other assistance programs

5. Family Impact Statement

What would receiving this scholarship mean for your family?

6. Provider Information

Have you completed a feeding therapy evaluation for a program you qualify for and are interested in pursuing?

Yes No

Provider name

Clinic/practice name

Provider email/phone

May we contact this provider if additional information is needed?

Yes No

What is Your Program / Practice of Interest?

Potential Provider Name

Clinic/practice name

Contact information

Have you reached out to them yet?

Is there anything else you would like us to know?

Consent & Agreement

Accept
● I certify the information provided is accurate to the best of my knowledge.
● I understand scholarship money is not guaranteed.
● I authorize The BITE Foundation to review this application for scholarship consideration.
● I understand that to help reduce the burden on families during the application process, initial applications are kept intentionally simple. Additional supporting documentation may be requested from selected applicants as part of the final review process.
● I understand that the information gathered is only for application purposes to be reviewed and approved by the board and that information will be held confidentially.

Signature

Date

Facebook-f Instagram Linkedin-in