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Philadelphia CHADD Membership Support Application

Philadelphia CHADD (Children and Adults with Attention-Deficit/Hyperactivity Disorder) is excited to offer funding for one-year family memberships to CHADD for families experiencing economic hardships and unable to afford membership fees. This membership support funding is made available through a one-time, limited grant from the CHOP Care Community grant program. Support is based on self-reported financial need.  A one-year membership will be made available to those who qualify.  Membership support will be awarded on a rolling basis until funding is no longer available. Awardees are encouraged to attend Philadelphia CHADD meetings held on the third Thursday of each month at 6 p.m. at CHOP’s Karabots Center, 48th and Market Streets.


For more information or to learn about CHADD, please


Please use the application below to apply. Your physician/health care provider may also submit the application on your behalf.

Return application by emailing it to or mailing it to Philadelphia CHADD, P.O. Box 20600, 2031 66th Avenue, Philadelphia, PA 19138

  (Please print neatly or type)

  Applicant’s Name: ______________________________________Daytime Phone: ____________________


Applicant’s Mailing Address: _________________________________________________________________


How did you hear about this opportunity? ______________________________________________________


Applicant’s E-Mail Address: __________________________


Is the applicant a current member of CHADD? (please circle)   yes   no

             (If yes, when does the current membership expire? ________________________)


Financial Need

Briefly describe the financial hardship and how the person or family may benefit from a CHADD membership (use additional paper if needed).









Person Completing Application: ___________________________Email Address: _______________________


Signature of Applicant: ____________________________________________ Date: ____________________