Talk Tools Scholarship Application
Applications will be accepted until October 28, 2016.

To apply for a Talk Tools scholarship, please complete the application below. New families
need to view an introductory video. After the application deadline you will receive notification
from The FOUNDATION with instructions for scheduling your appointment including choice of
dates and times.

Parent Information
First Name:
Your answer
Last Name:
Your answer
Address 1:
Your answer
Address 2:
Your answer
City:
Your answer
State:
Phone Number:
Your answer
Email:
Your answer
Applicant Information
Child's First Name:
Your answer
Child's Last Name:
Your answer
Age:
Your answer
Program Information
Does your child currently receive speech therapy?
Has your child been evaluated by a Talk Tools Therapist?
If you are requesting a follow-up appointment, please provide the date of your last eval.
Your answer
If you have had a previous evaluation please answer the following questions.
Please select the months you participated in a Skype Session:
Required
What areas do you feel you need the most assistance with?
Your answer
What areas do you feel you need the most assistance with?
Your answer
How many days per week on average are you able to work on any part of your program plan?
Your answer
Which specific activities do you find easiest to implement?
Your answer
Do you have a therapist assisting you in implementing this program plan?
Your answer
Scholarship Amount
Please let us know the scholarship amount required. You can request any amount necessary for your family to participate in the clinic. It is not guaranteed you will receive the full amount requested. It is our goal to allow as many families as possible to participate so we will do our best to accommodate every need. Please take into consideration if you can afford to pay for a portion of your evaluation, that will allow another family the opportunity to participate. There are a limited number of full scholarships available.
Requested scholarship amount:
If you do not need a scholarship please enter 0.
Your answer
Other Information
Comments:
Your answer
Required
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