TouchChat Application
Please complete the following application as thoroughly as possible. We will use this information to provide TouchChat with a description of your child, so the more information we have the better we can understand the need.
Parent/Caregiver Name
Email
Phone
Annual Household Income
Please choose the category that best describes your household's total annual income.
$0 to $49,999
$50,00 to $99,999
$100,000 and up
$0 to $49,999
Child/User First Name:
Age:
Diagnosis:
Describe your child/user.
(E.g. strengths and weaknesses, likes and dislikes, and any additional information you would like to share.)
Please tell us why are you applying for TouchChat, it's intended purpose, and why you have been unable to purchase this app yourself.
Please upload proof of diagnosis.
Delete all uploads
Choose files or drag here
Please upload any supporting documentation from Speech Language Pathologist or related professionals.
(E.g. AAC evaluation, letter of support)
Delete all uploads
Choose files or drag here
By checking this box, I agree that this is a grant request, and that while all requests are read and processed, not all can be fulfilled. iTaalk will do everything possible to meet the needs of every applicant.
I agree
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