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Jean Wolff-Rossi Fund for Participant Involvement (Rossi Fund) Application Form

(ONLY ONE NAME PER APPLICATION.)

An application must be received by NCCDD 15 days prior to the first day of an in-state event and 30 days prior to first date of an out-of-state event. Applications are funded on a first-come, first-served basis. The NCCDD reviews applications frequently, and the decisions on all applications will be mailed in writing to all applicants.

NOTICE! Increased Funding Available for 2024 National APSE Conference on Competitive, Integrated Employment in Charlotte!

NCCDD is increasing the $600 per year, per person, per household Jean Wolff-Rossi Fund for Participant Involvement limit for in-state events to $1,200 for the 2024 National APSE Conference “Navigating Tomorrow Together” event at the Sheraton / Le Meridian Hotel & Conference Center in Charlotte, NC. The single activity or event limit of $2,400 is also now $10,000 for the 2024 National APSE Conference. See, below, for the Rossi-Fund Application Form (Click ‘Apply Online’).

2024 National APSE Conference: “Navigating Tomorrow Together”

National APSE is the only national membership organization focused exclusively on Employment First to facilitate the full inclusion of people with disabilities in the workplace and community (National APSE Website, n.d.).

Main conference: Tuesday, June 18-20, 2024
Pre-conference: Monday, June 17, 2024

Early Bird Rate Ends March 31, 2024

If you need assistance completing this application, please contact 1-800-357-6916.

Customer Information

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Please specify your email address.

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Disability Connection (required):

To meet the criteria for receiving funds from the Jean Wolff-Rossi Fund for Participant Involvement it is essential that the following information is completed. (Incomplete applications may be returned to applicants for completion.)

(Check all that apply):

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Ethnic Status (optional)

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Event You Plan to Attend and Seek Financial Assistance (required): (NOTE: With this application, you MUST submit the Official brochure with event description, agenda/schedule, and registration form or the same information copied from the official event website.)

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Event Start Date:
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Event End Date:
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Statement of Purpose (required):

In the space provided below, please write a brief statement explaining your goals related to this particular event.
Answer these three questions:

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Financial Assistance is Needed For (required):

The Jean Wolff-Rossi Fund for Participant Involvement (Rossi Fund) can only partially fund the cost of attending an event. Rossi Funds are available to reimburse individuals for the types of expenses listed below (individuals may apply for funds to cover up to 3 of these expense categories).

Please indicate the amount of funds you are requesting – You may apply for funds from up to 3 of the expense categories listed below. There is a limit of $600 per year, per person, for in-state events and up to $800 per year, per person, for out-of-state events:

Check up to 3 Rossi Funds Requested Notes (date)
Conference/seminar registration $ The Rossi Fund will only pay the “early bird” registration fee rate.
Hotel/Lodging $ # of nights  x $ per night (up to $98 plus tax in-state; $98 plus tax out-of-state)
Transportation
(List estimated mileage cost or other type of
transportation
- bus, train, etc.)
$

From (city, state): 

To (city, state):


(67 cents/mile – NC State government rate is subject to change)
Round-trip mileage x 67 cents/mile = $


Round-trip mileage x 33 cents/mile (over 100 miles)
or other transportation (type):

Method of Travel Expected:
Please leave empty which is not needed.

1. Airplane Travel Cost :
2. Train Travel Cost :
3. Bus Travel Cost :
4. Uber/Cab Travel Cost:
5. Car Rental Cost:

Expected Cost Round-Trip of Travel Method/s:  (Sum of 1 to 5)

Total cost of transportation: Mileage + Other Method of travel  


Other expenses are at the discretion of the NCCDD

Respite/Child Care $ # of hours  x $ days x $15.60/hr. (max. $150/day)
Personal Attendant Services $ # of hours  x $ days x $15.60/hr. (max. $150/day)
Total* $

I have read and meet the criteria of the guidelines, meet the definition of developmental disability given, and completed this application with all information requested. I have also enclosed the official brochure with event description, agenda/schedule and registration form or the same information copied from the official event web page/site.

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SUBMIT FORM (form will clear with each submission)

DISCLAIMER:
The Jean Wolff-Rossi Fund for Participant Involvement (Rossi Fund) is not an entitlement. NCCDD reserves the right to use discretionary judgment on any application they deem appropriate. Funds will be distributed consistent with the Council’s mandate in Federal Law for commitment to systems change, advocacy, and capacity building.

*Incomplete applications may be returned to applicants for completion.

**DO NOT SUBMIT WITHOUT PROVIDING WEB PAGE/SITE LINK TO THE OFFICIAL EVENT SITE WHICH SUPPORTS ACCESS TO EVENT DESCRIPTION, AGENDA/SCHEDULE, AND REGISTRATION FORM.**.

Proof of submission: You will receive a return e-mail to confirm your submission. If you have not heard from the Rossi Fund in three days, please give us a call.

US MAIL:
NCCDD Rossi Fund
2010 Mail Service Center
Raleigh, NC 27699-2010

EMAIL: [email protected]

FAX: 984.920.8201

PHONE: (919) 527-6500, (Toll Free Voice/TDD) 1-800-357-6916

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North Carolina Council on Developmental Disabilities

Office Hours: 9AM-4PM Monday-Friday
3109 POPLARWOOD COURT, SUITE 105,
RALEIGH, NC 27604
 
1-800-357-6916 (Toll Free)
984-920-8200 (Office/TTY)
984-920-8201 (Fax)
 
This project was supported, in part by grant number 2001NCSCDD-02, from the U.S. Administration for Community Living, Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects with government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official ACL policy.

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