Grant Application

Babies with iPads Grant Application



Child’s Name:




DOB:

Your Name:






Physical Address:








Email Address:

Phone Number(s):






Child’s Diagnosis:










Child’s Therapist/Teachers/Services:














If granted an iPad, I have access to a computer with an iTunes account. Yes/No


If granted an iPad, I am confident in choosing appropriate apps. Yes/No


If granted an iPad, I can provide pictures, videos, and/or updates to Babies with iPad. Yes/No


Where did you hear about this grant?_________________________






Signature________________________________________

Babies with iPads is not responsible for any damages or repairs to your iPad after it has been delivered.






Babies with iPads Grant Application Page 2





My child currently struggles with:










An iPad would provide my child with:





























My goals for using an iPad with child include:


 
 
 
 
 

Please include any other information you feel will help the committee better understand your child's needs.  Suggestions include pictures, therapist recommendations, reports, etc.