Sample Materials
Funding Worksheet

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It is important to pull together all of the information you will need before seeking funding. Use the following list to write out information that you will need. Click on the buttons next to each item to view additional information from "Developing a Funding Strategy" to help you complete your worksheet.

Write out what areas in your life that you think AT could help you? Why do you need AT? Will the device or service enable you to enter or continue employment, live more independently, enter or continue schooling, or create or restore function on one or more life areas (e.g., walking, seeing, hearing, communicating)?

See Step 1

 ____________________________________________________________

Which professionals need to write support or justification letters?

See Step 2

__ physician
__ therapist specify:
__ educator
__ counselor
__ other 

Name of vendors from whom the AT can be purchased, specific information about type of AT (including cost, fabrication needs, etc.) List the first and second choices for the devices, including vendors, and approximate costs.

See Step 2

___________________________________________________________________

Review past, current, and potential funding sources (based on searches of this database). Prioritize your list according to sources that may more closely match your needs and list those sources here.

See Step 3

____________________________________________________________________

Collect the following paperwork :

See Step 4

__ Information about your age, disability/medical diagnosis, prognosis, evaluation reports, etc
__ Information about your financial status, including private insurance coverage, employment status, level and source of income, etc.
__ Information about public or governmental programs that you have previously used
__ Recommendations for specific assistive devices including the name and manufacturer of the equipment, the cost,
__ Other information that documents the person's need for the assistive technology
 

List other information/paperwork that you may need below:
___________________________________________________________________

___________________________________________________________________

___________________________________________________________________

List possible services or ongoing support the person may need to use the assistive technology successfully. (Examples: evaluations, training, maintenance, upgrades, etc.)

____________________________________________________________________


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