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SCHOLARSHIP APPLICATION
What is your child's name, age, diagnosis & date of diagnosis?
*
Is your child verbal or non-verbal?
*
VERBAL
NON-VERBAL
Does your child use a speech generating device?
*
YES
NO
Who recommended you to receive toys/equipment? (i.e. OT, PT, Teacher, etc.)
*
What types of sensory equipment can your child benefit from?
*
What is the estimated cost of items your child would use the scholarship money for?
*
Where does your child attend school?
*
Does your child receive any additional services?
*
NO
YES
Does your child have behavioral difficulties?
*
Your Name (First, Last) and Email
*
Submit
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