SATB2 Gene Foundation iPad for Communication Grant Application
Through the generosity of The GPD Employee Foundation, the SATB2 Gene Foundation has been awarded a grant to support communication for individuals with SATB2-associated syndrome (SAS). This grant will provide three iPads with case, loaded with the Proloquo2Go app, and is intended to support families who have had difficulty obtaining access to these communication devices through either insurance or the school system. Applications must be received by Wednesday, June 7, 2023 at 5pm EST for consideration. Applying for funds does not guarantee funding. Grant award decisions notifications will be sent via email the week of June 26.
APPLICATION TERMS
1. Assistance will only be provided to individuals with a confirmed SATB2-associated syndrome diagnosis by a medical professional; documentation/verification will be required no later than Wednesday, June 7, 2023, 5pm EST for an application to be considered. Confirmation of diagnosis options are provided in this application.
2. Your SAS dependent must reside in the United States due to shipping considerations.
3. The application deadline is Wednesday, June 7, 2023, 5pm EST.
4. This grant is only intended to fund the purchase of an iPad and Case with the Proloquo2Go app. No deviations will be allowed. Equipment will be purchased by the SATB2 Gene Foundation and shipped directly to recipients.
5. The Board of Directors will review applications and notify approved applicants the week of June 26, 2023.
6. As there are often more applications for funding than can be supported, the board will prioritize applications from families in need who have yet to receive funding from the SATB2 Gene Foundation. Please note that there is a limit of one (1) SATB2 Gene Foundation grant award, whether for the Family Assistance Program or the iPad for Communication Grant, per SAS dependent over a 3-year period (look back is currently from 2020 through 2022).
7. Recipients of the grant will be required to provide a testimonial and photo to be used for reporting purposes.
8. Disclaimer: The SATB2 Gene Foundation is a 501(c)(3) non-profit organization that does not discriminate against age, gender, sexual orientation, race, disability, or religion. If you have any questions, please contact us at info@satb2gene.org.
Do you agree with the APPLICATION TERMS above?
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Yes
No
Name of individual with SATB2-associated syndrome
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First Name
Last Name
Birthday of the individual with SATB2-associated syndrome
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-
Month
-
Day
Year
Does your SAS dependent have a confirmed diagnosis by a medical professional?
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Yes
No
Is your SAS dependent currently enrolled in Dr. Zarate's SAS Clinical Registry?
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Yes
No / Unsure
Please provide the medical diagnosis for your SAS dependent:
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I will upload it as part of this application
I will email it to info@satb2gene.org no later than Wednesday, June 7th.
Please upload your SAS dependent's medical diagnosis here.
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Full name of parent/caregiver completing the application
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First Name
Last Name
Email
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example@example.com
Phone Number
Please enter a valid phone number where we can reach you if necessary.
Full Mailing Address
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Street Address
Street Address Line 2
City
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Tennessee
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Washington
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State
Zip Code
Please describe in detail why you are applying for this grant and the impact that you believe this communication device will have on your SAS dependent if you receive it. Please provide background on the SAS individual's current level of communication, preferred communication methods, and speech therapy history/frequency.
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Have you previously sought to purchase an AAC device through private insurance, Medicaid, the school district, or private sources of funding? Please give as much detail as possible about decisions and outcomes.
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What support do you have in place for the implementation and training of an AAC device?
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Does the individual currently have an AAC device?
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Yes
No
If yes, please indicate why you are seeking this support.
Have you received Family Assistance Funds or other financial assistance funding from the SATB2 Gene Foundation in the past 3 years (2020 - 2022)?
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Yes
No
Unsure
Do you currently have private insurance?
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Yes
No
Do you currently have Medicaid?
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Yes
No
ANNUAL Household Income in US Dollars
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0 - $49,999
$50,000 - $99,999
$100,000 - $149,999
$150,000 - $199,999
$200,000 or more
Total number of people living in your household.
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Is there anything else you would like to share to support your request for this communication device?
By clicking yes, I affirm that all of the information entered in this application is accurate to the best of my knowledge.
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Yes, I affirm
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