Teacher Next Steps: Apply for Adaptive & Assistive Equipment - Special Education Foundation of St. Louis

Introduction

Through a grant from the Tilles Foundation, Special Education Foundation is able to support Special School District students by purchasing adaptive equipment that allows social interactions and builds confidence for those who are physically challenged. The grant provides funds for augmentative communication equipment/devices and computer and adaptive equipment that support independence. Funds from the grant open the doors for student success and increase opportunities for independence. Funds are limited.

This application can only be submitted by the student's teacher. You will receive an email letting you know that your request has been received by our office.

After you complete and submit this application the parent/guardian will receive an email from the SEF office listing "Parent/Guardian Next Steps". The parents will be instructed to sign a release form (that SEF will attach to the email and submit their most recent tax return, Form 1040 pages 1 & 2, removing any social security numbers on the form). If the parent/guardian does not send the required information to our office, SEF will contact the parent/guardian to obtain the requested information. If, after several attempts (phone, email, letters), we do not receive the information from the parent, SEF will contact the teacher and let him or her know that we are unable to process the application.

Submitting this application does not guarantee approval.

Our Program Committee will determine approval after all information has been received.

SEF will inform the teacher and parent/guardian(s) of the decision via email and/or letter.

If the request is approved, SEF will order the equipment. Please allow at least 3 to 4 weeks for delivery, once the application has been approved and equipment ordered. Equipment will be delivered to the SEF office for processing (exceptions will be handled on a case-by-case basis).

SEF will bundle and label the equipment and deliver it to Nikki Brentlinger, Special School District’s Assistive Technology Area Coordinator. Nikki's office will contact the teacher to arrange pick-up.

Questions? Contact SEF at 314-394-7030 or email the Foundation at info@sef-stl.org

ALL APPLICATIONS MUST BE SUBMITTED ONLINE. Click here for a PDF preview of the form questions.

Applicant Information

Applicant's Name*

First Last

School Attending*

District*

Grade Level*

Parent/Legal Guardian(s) Name*

Home Address*

Street Address Address Line 2 City State ZIP Code

Parent's Email*

Home Phone*

Equipment Requested

Detailed Description of Equipment Requested*

Include style number, color, and price.

Manufacturer*

Quote Number

Manufacturer's Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Manufacturer's Website*

Stock Number(s)*

Price*

Statement from teacher that supports equipment need*

Statement describing how equipment will assist student independence and/or employment*

Upload the quote for the equipment from the manufacturer.

Accepted file types: pdf, doc, docx, xls, xlsx, csv, txt, rtf, html, zip, jpeg, png, gif, Max. file size: 20 MB.

Teacher Information

Teacher's Name*

First Last

Teacher's Phone*

Teacher's Email*

School*

District*

School Address*

Street Address Address Line 2 City State ZIP Code

By initialing below, I confirm the parent/guardian(s) is aware that equipment is being requested for their child and that additional information will be sent from SEF by email directly to the parent/guardian(s).*