The Sensory Project - Application Form

The Sensory Project - Application Form

Thank you for your interest in The Sensory Project! Our mission is to provide sensory equipment to individuals living within the greater Kansas City area who need support in achieving success at home. Please complete the form below to apply for assistance.
Applicant Information*

*Eligible for residents living within the greater Kansas City area only - If applying on behalf of someone else, please provide their information.
Full Name*

First NameMiddle NameLast Name
Birth date*

MonthDayYear
Relationship to applicant:*
Parent/guardian name (if applicable)*
Email address*
Name@example.com
Phone number*
Please enter a valid phone number.
Home address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Sensory Needs and Equipment Request
What sensory challenges does the applicant experience? (Check all that apply)*

Sensory sensitivity (e.g., noise, light, textures)Sensory seeking (e.g., movement, deep pressure)Difficulty with focus and self-regulationAnxiety or overstimulationOther
What type of sensory equipment would be most beneficial? (Please choose 1)*

Weighted BlanketNoise-Canceling HeadphonesCrash PadFidget toolsCompression VestOther
How would receiving this equipment help the applicant at home?*
Does the applicant currently receive any sensory support at school or therapy?*

NoYes
If yes (please describe):
Is there anything else you’d like us to know about the applicant’s needs?
How did you hear about The Sensory Project?*

WebsiteSocial mediaTherapist/teacherFriend/familyOther
Agreement & Signature
I certify that the information provided in this application is true and complete. I understand that The Sensory Project will review my application and determine eligibility based on available resources.*

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The Sensory Project - Application Form

Applicant Information*

Sensory Needs and Equipment Request

Agreement & Signature