Beyond The Label

Scholarship Application

Please fill out this application as thoroughly and completely as possible. We want to help as many individuals and/or families as possible, BUT our funds ARE limited. At this time, Scholarship Funds will ONLY be available to NAPA COUNTY RESIDENTS.

This IS an application process, so the more specific information you can provide the better

PLEASE NOTE: We will ONLY be granting funds for AAC/communication devices, expenses related to therapies for special needs individuals, learning tools for special needs children, regulatory/sensory items, events that directly support special needs families, and/or special needs classroom items.

Name

First Name

Last Name

Child’s Name - if you’re applying on behalf of a minor

First Name

Last Name

Recipient’s Birthdate

YYYY

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

What type of Scholarship assistance are you looking to receive?

(AAC applicants) Do you already have an iPad that can be used as a dedicated AAC device?

Yes

(AAC Applicants) An AAC is a robust communication device that requires a lot of initial education, modeling, and support of the AAC user. Please explain what research and/or education you’ve done to support the user’s success with an AAC device.

I.E. working with an SLP, taking an online course, past experience with an AAC device, etc

(AAC Applicants) Which AAC Program (Proloquo2Go, Proloquo, TouchChat, LAMP, etc) are you requesting Beyond The Label purchase for your AAC user? And WHY that Program?

Please explain the research you’ve done in determining which Program is best for your AAC user.

Please provide background information on the recipient’s diagnosis/disability OR how this might best support a special needs individual you serve (teach, etc.) :

Please explain why you/the recipient are in need of Beyond The Label Scholarship Funds, and please be as detailed as possible with your information and specific requests of Funds:

Please explain exactly what you/the recipient are requesting of Beyond The Label Scholarship Funds, and please be as specific as possible:

If there is a specific link to what you’re requesting, please place that here. Also include the cost involved with what you’re requesting.

If you are requesting a therapy/service expense to be paid for please input all of the providers information here:

Name of the business, address of the business, days/times attending therapy/service, etc

What is the total cost of the item/service/therapy you’re requesting?

Please input the amount of money you are requesting Beyond The Label spend for your Scholarship Application.

Please explain other avenues you’ve explored to help meet your needs (i.e. insurance, NBRC, NVUSD, etc)

Beyond The Label

Scholarship Application

Beyond The Label

Advocating for Acceptance + Inclusion

***

Advocating for Acceptance + Inclusion ***