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.
