AAC Recipient Application Form

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PLEASE NOTE: As of April 2025, we have received more applications than we can supply at this time. Please note, we have suspended distribution at this time. You can use this form to register your interest but be aware that there is likely to be a long wait for a device.

For more information please go to our website www.freetalker.org

Our aim is to provide an AAC device and appropriate software to 100 individuals in order to support their communication journey. Below is the criteria and information we need to make this process work smoothly. Please complete this form which will be stored securely by the campaign team. Your data will not be shared with any third party without your consent. However, when providing information, please keep in mind we will need to ensure that the we have all the relevant information we need to provide the right devices and software. Suppliers of the software will need additional information in order to support access to the software as well as appropriate support with programming etc.

CRITERIA: In order to ensure the right support is provided, the application must be made with support of someone with experience or access to support the set up and use of the AAC device. This could be a speech and language therapist, teacher or AAC Specialist Supplier.

Email *

Record my email address with my response

Preferred Software *

Grid for iPad

Proloquo2Go

Other:

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