Apply for a Freedom Trax Grant
Don't let cost stop your family from getting the equipment they need. The Freedom Trax Grant is for families who would need a device, but may lack the financial means to purchase.
Are you applying for yourself?
*
Yes, I am applying for myself
No, I am applying for a friend (or relative)
How soon is the device needed?
*
ASAP
This Month
No Rush
Why is there a need? (Describe the family's situation)
*
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Contact Details
Please provide your contact details. If you are selected, we need a way to reach out.
Your Name
*
First Name
Last Name
Your Email
*
example@example.com
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Their (client) Contact Details
We limit grants to one per recipient. The name and email of your recipient allow us to verify uniqueness.
Their Name
*
First Name
Last Name
Their Email
example@example.com
Their Age
*
Their Diagnosis / Disability
Their Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Submit
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