2026 Individual Grant Application

PLEASE READ: To help us serve as many children as possible, we kindly ask that each individual submit only one application. You may apply for either the Speech Tablet or Sensory Items, but not both.(Required)

I understand that I can only apply for the speech tablet, OR sensory items, but NOT BOTH.

Grant Recipient Information

Grant Recipient's Name(Required)

First Last

Gender(Required)

Male

Female

Prefer not to answer

Date of Birth(Required)

Contact Information

Parent or Guardian

Contact Name(Required)

First Last

Contact Email(Required)

Contact Phone(Required)

Alternate Phone(Required)

Please do not use your work phone number

Alternate Email(Required)

Please do not use your work email address

Mailing Address(Required)

Street Address City State / Province / Region ZIP / Postal Code Country

Diagnosis Information

Provide a Diagnosis(Required)

Please provide a brief description of the diagnosis of the individual(s) for whom you are applying for the grant.

Upload diagnosis documentation(Required)

Please upload documentation to provide proof of the diagnosis/diagnoses of the individual(s) for whom you are seeking the grant.

Accepted file types: jpg, gif, png, pdf, Max. file size: 50 MB.

Grant Item(s)

Requested Item(s) (Maximum amount of $750)

Sensory Items (Please provide a list in the field below)

Other (Please provide a description in the field below)

Sensory Items List(Required)

Please provide a list of items along with links to the site from which the item(s) may be purchased (e.g. amazon.com, Walmart.com, etc.)

Other Requested Item(s)(Required)

No clothing or shoes can be requested. Please provide a list of items along with links to the site from which the item(s) may be purchased (e.g. amazon.com, Walmart.com, etc.) Please Note that follow up questions may come from a member of our staff prior to approval.

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