Grant Application

Babies with iPads Grant Application

Child’s Name:


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?_________________________


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.