ADFP Application Form - 2025 edition

Assistive Devices Funding Program Application - 2025

Important information: If you are applying for multiple items, please complete this application form for each item and submit it seperately.

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

2025 ADFP Equipment List

2025 ADFP Guidelines

2025 ADFP Printable Application

Fields marked with a red * are required fields

* 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.

Date

yyyymmdd

Applicant Information

Lifetime Membership Number:*

Note: The Assistive Devices Funding Program 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 Assistive Devices Funding Program?

YesNo

When was the last time you received funding from ADFP?

MonthDayYear

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

Equipment

2024 ADFP Equipment List

Documentation Required: Current letter from a Health Professional providing the rationale for Equipment/Item/Material*

Browse Files

Equipment Requested

Equipment Category

Please refer to the 2024 ADFP Equipment List linked above to determine the Equipment Category.

Has above Equipment been ordered or received? Please note: An item that has been ordered or received does not guarantee application approval.

YesNo

Documentation Required: If the requested Equipment is covered by Assistive Devices Program from the Ministry of Health and Long-Term Care, please provide the Ministry of Health - Assistive Devices Program Approval Confirmation Sheet

Browse Files

Would you like to manually enter information from the ADP Approval Confirmation Sheet?

YesNo

Amount approved / Pending approval:

Please indicate the amount of funds approved by ADP or pending approval.

Date of Approval

MonthDayYear

Expiry Date of Approval

MonthDayYear

Signature of Health Professional*

Name of Health Professional*

Please indicate the name of the health professional verifying the approval.

Vendor Quotes

Name of Preferred Vendor

Please enter the name of the preferred equipment Vendor.

Preferred Vendor Quote *

Enter the cost of the Equipment listed in the Quote (exclude labour and installation fees).

Documentation Required: Copy of Preferred Vendor Quote *

Browse Files

Name of Alternate Vendor

Please enter the name of the alternate equipment Vendor.

Alternate Vendor Quote

Enter the total cost of the Equipment listed in the Quote (exclude labour and installation fees).

Documentation Required: Copy of Alternate Vendor Quote *

Browse Files

Funding Sources

Is the Equipment Covered by ADP?

YesNo

Amount Approved or Pending Approval by ADP*

Enter Amount Approved or Pending Approval or 0 if Not Applicable.

Please indicate which (if any) of the provincial programs you are receiving.*

Other:

List other programs above.

In order to process funding applications, OFCP requires a copies of any/all written response(s) from the Ontario Ministry of Health – ADP, ODSP, and/or Assistance for Children with Severe Disabilities Program indicating the agencies Approval or Denial of funding the item/equipmment requested.

Please indicate Application Status from the funding sources you have already applied to:*

	Applied	Not Applicable	Approved	Denied	Written Response Attached
Ontario Disability Support Program (ODSP)
Ontario Works
Local City Social Services
City of Toronto Hardship Fund
Assistance for Children with Severe Disability (ACSD)
Community Agencies
Private Insurance
Other

Other:

If applicable, list other Funding Sources contacted above.

Documentation Required: Written Responses from Applicable Funding Sources*

Browse Files

Please attach all Written Responses from the Funding Sources indicated in the table above. Please include copies of any approval amounts from Funding Sources.

Calculation of Outstanding Equipment Cost

A) Cost of Equipment

Equipment Cost from Preferred Vendor Quote (excluding labour / installation).

B) ADP Approved Amount

Amount of Funding Approved by ADP.

C) Other Approved Funding Sources

Number of Additional Funding Sources

Please enter the number of additional Funding Sources from 0-5.

Funding Source 1

Funding Source 2

Funding Source 3

Funding Source 4

Funding Source 5

D) Total Funds Outstanding (A - B - C = D)

Amount of Funds Outstanding in $

Total Funds Requested from OFCP

Total Funds Requested from OFCP. Note: ADFP applications are eligible to receive coverage for up to 25% of the total Equipment to a maximum of $2000.00.

Total % Coverage Requested from OFCP

Total Funds Requested from OFCP. Note: ADFP applications are eligible to receive coverage for up to 25% of the total Equipment to a maximum of $2000.00

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 supply of the equipment 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 prescribing, recommending equipment, selecting a vendor/contractor or in the relationship between the purchaser and vendor of the equipment and that any payment from the OFCP Assistive Devices Funding Program is not an acknowledgment that the equipment 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 OFCP website.

Certification

I certify that the information provided in this application is true, correct and complete to the best of my knowledge and that the equipment has not been received. Approval of this application in this funding year does not guarantee approval in concurrent years.

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

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

Yes

I certify 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 of the ADFP Program criteria & guidelines*

Yes

Date*

yyyymmdd

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 Ontario Federation for Cerebral Palsy.

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