LEAF Application Form - 2025 edition

Life Enriching Activities Fund Program Application - 2025

Life Enriching Activities Fund (LEAF) Application 2025

Complete this application form in full. Attach all required documentation. Incomplete applications will be returned.

2025 LEAF Guidelines

If you require additional information, or require assistance completing this application or have any questions please contact the Funding Department at the Ontario Federation for Cerebral Palsy.

Email: funding@ofcp.ca
Phone: 416-936-6007
Toll Free: 1-877-244-9686, Ext 221.

Fields marked with a red * are required fields.

Application Date*

yyyymmdd

Applicant Information

Lifetime Membership Number:*

Enter your Lifetime Membership number only (excluding LM). Note: The Life Enriching Activities Fund is only available to individuals with a Lifetime Membership with the Ontario Federation for Cerebral Palsy. If you require a confirmation of the Applicant's Lifetime Membership number please contact Membership Services at membership@ofcp.ca or (437) 655-3376

Applicant Name

First NameLast Name

Date of Birth

yyyymmdd

Address

Street Address

Street Address Line 2

CityProvince

Postal Code

Applicant Primary Phone Number

Please provide the phone number in the following format: (555) 555-5555

Email

example@example.com

Has the applicant previously received funding from OFCP's LEAF?*

YesNo

What calendar year did the applicant last receive funding from LEAF?

Additional Contacts

Would you like to assign a Primary Contact other than the Applicant?

YesNo

Primary Contact Name (parent or guardian required for applicants under eighteen years of age)

First NameLast Name

Relationship to Applicant

Address

Street Address

Street Address Line 2

CityProvince

Postal Code

Primary Contact Primary Phone Number

Please provide the phone number in the following format: (555) 555-5555

Primary Contact Email

example@example.com

Would you like to assign an additional contact to assist with communication?

YesNo

Communication Contact:

First NameLast Name

Communication Contact Primary Phone Number:

Please provide the phone number in the following format: (555) 555-5555

Communication Contact Email:

example@example.com

Communication Contact Relationship to Applicant

Life Enriching Activity

Activity Requested*

Describe the activity above.

In what way(s) would this activity enrich your life?*

Activity Start Date (if applicable)

MonthDayYear

Activity End Date (if applicable)

MonthDayYear

Funding Summary

Total Cost of Activity*

Name of Provider*

Please enter the name of the provider.

Documentation Required: Copy of Activity Cost Quote/Invoice/Paid Receipt

Browse Files

Would you like to provide receipt details manually?

YesNo

Is your application for Physical Support Services?

YesNo

Manual Receipt Entry for Physical Support Services

Signature of Attendant

Manual Receipt Entry

Signature of Named Service Provider

Signature of Applicant/Parent/Guardian

Total Funds Requested from OFCP*

Total Funds Requested from OFCP. Note: LEAF applications are eligible to receive coverage up to a maximum of $300.00.

If approved, where should funds be directed?*

Bank Account of Applicant or Primary ContactProvider

Please attach a copy of a direct deposit form and/or void cheque for the bank account

Browse Files

Financial Need

Please indicate your annual Household Income*

Please provide any additional context regarding your financial circumstances. This information will be used by OFCP to assess and process your application.

Indemnity

I hereby indemnify and save harmless the Ontario Federation for Cerebral Palsy, its officers,
directors, employees and agents from and against any and all claims, demands, liabilities, losses, costs, expenses, damages, actions, suits and other proceedings arising out of the activity described in this application. I understand that the Ontario Federation for Cerebral Palsy acts as a third party funder and as such has no role in choosing, recommending or selecting an activity, product or equipment and that any payment from OFCP LEAF program is not an cknowledgement that the activity is acceptable for the purposes intended.

Privacy

The OFCP collects, uses and discloses personal information related to this application only for
the purposes of assessing, processing and administering this application and may exchange such
information with the above-mentioned contact person, vendors, medical professionals and other
agencies. I consent and (as applicable) confirm the user’s consent to this collection, use, disclosure and exchange of personal information. For additional information regarding the OFCP’s personal information protection privacy practices, please refer to our Privacy Policy on the OFCP website.

Certification

I certify that the information provided in this application is true, correct and complete to the best of my knowledge.

By checking the ' I agree and give permission to process this application ' box below, as the applicant or applicant parent or guardian, you are giving permission to OFCP staff to process your application accordingly and will indicate that you have read the LEAF guidelines and application.

By agreeing to the above terms, as the applicant, I am giving permission to OFCP staff to process this application accordingly*

I agree and give permission to process this application

By agreeing to the above terms, as the applicants' parent / guardian, I am giving permission to OFCP staff to process this application accordingly*

I agree and give permission to process this application

Please ensure all information and supporting documentation are provided. If any information is missing or the application is incomplete, the applicant or primary contact person will be notified for completion and submission of missing information.

If we do not hear from the applicant within three weeks the application will no longer be active.

If you require additional information, or require assistance completing this application or have any questions please contact the Funding Department at the Ontario Federation for Cerebral Palsy.

Email: funding@ofcp.ca
Phone: 416-936-6007
Toll Free: 1-877-244-9686, Ext 221.

Do we have permission to use your story in OFCP promotional materials?*

YesNo

Date*

yyyymmdd

I acknowledge that the information provided in this application is true, correct, and complete to the best of my knowledge.*

Yes

I confirm that I have read and understand all criteria and guidelines relating to OFCP's LEAF Program*

Yes