• Please note: Online application requires you to have all your documents in electronic format AND attach them at the bottom of this form

  • ADFP Application - 2021

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

     

    Fields marked with a red * are required fields

     

     

    * If you require additional information regarding this application or have any questions please contact us.

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  • Applicant's Information

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  • Primary Contact (if applicable)

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  • Equipment

  • An item that has been ordered or received does not guarantee approval of funding from this program.


    Documentation Required: Health Professional current rationale letter for all items. If requested item is covered by ADP Ministry of Health and Long-Term Care, please have your health professional complete enclosed ADP Approval Confirmation Sheet and submit with application.

  • Documentation Required - You can attach electronic copies from listed vendors at the bottom of this form.

  • Other Funding you have accessed: OFCP requires that you approach applicable funding sources prior to, or in conjunction with, submitting your application to OFCP. Please check which funding sources you have already applied to:

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  • (For possible other funding sources, please see attached Addendum A)


    If response was in writing, please include a copy with this application.

  • Complete the calculation below which applies to your request.

     

     

    Purchase Equipment/Item/Material - Calculation of Request for Financial Assistance.

  • C) Other Funding Obtained

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  • 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.

     

     

     

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  • Supplemental ADFP Application Forms 

    ADP APPROVAL CONFIRMATION SHEET - Please have your prescribing Health Professional (Occupational or Physiotherapist) complete this sheet if the item you are requesting funding for has been approved by the Assistive Devices Program (ADP), Ministry of Health and Long-Term Care.

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  • 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 two weeks the application will no longer be active.

    If you require additional information regarding this application or have any questions please contact the Ontario Federation for Cerebral Palsy


    416-244-9686 ext: 221 or toll free 1-877-244-9686 ext: 221

    Email: adfp@ofcp.ca

     

  • Please note: Attach documents to this online application BEFORE you click SUBMIT below.

    The save button below allows you to save a partial filled out application, (you DO NOT have to login - connect with google or facebook, you can click 'Skip Create Account' ) and it will send you an email with your form and a link, and clicking that link would bring you back to your partialy filled out form, so you can continue to finish it, then submit it.

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