Holiday Adaptive Toys 2024

APPLICATIONS OPEN OCTOBER 1 - DECEMBER 1, 2024

“A holiday is an opportunity to journey within”

— Prabhas

Step 1: Eligibility

Children are eligible for equipment based on the following criteria:

17 years of age or under
Lives in the Greater St. Louis Region
Referral by a social worker, case manager, etc. is a must
Requests up to $250
Applications open each year on October 1st.

Step 2: Holiday Adaptive Toy Application

Complete the application below.
(The application cannot be saved in the middle. Once begun, it must be completed in order for The Arya Foundation to receive it.)

Holiday Adaptive Toy Form

Child's Information

Child's Name

First Name

Last Name

Birth Date

YYYY

Qualifying Medical Condition

Permanent Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

County

Parent/Legal Guardian Information

Parent/Legal Guardian Name

First Name

Last Name

Phone

(###)

###

####

Adaptive Toy Information

Name of Adaptive Toy

URL Of Adaptive Toy

Cost of Adaptive Toy

Requested Funding Assistance

If cost of Adaptive Toy is more than $250, how will the remaining funds be paid?

Type N/A if cost of Adaptive Toy is less than $250

Missouri Children with Developmental Disabilities Waiver a.k.a Sarah Lopez Waiver

Does your child have a Missouri Children with Developmental Disabilities Waiver a.k.a. Sarah Lopez Waiver?

If yes, please email or mail the adaptive equipment denial letter to The Arya Foundation at info@TheAryaFoundation.org or P.O. Box 4443, Chesterfield, MO 63006

Referral Information

Name of Person Referring

First Name

Last Name

Organization of Person Referring

Email of Person Referring

Phone of Person Referring

(###)

###

####

Affirmation and Consent

In order for The Arya Foundation, a non-profit organization, to advance financial assistance for the purchase of adaptive toys, the undersigned do hereby affirm as follows: 1.The undersigned are the parents or guardians of the child. 2.The undersigned further agree(s) to return any unused funds immediately to The Arya Foundation so that those funds can be utilized by the organization to benefit other families. The Arya Foundation reserves the right to distribute funds at its sole discretion. The Arya Foundation may pursue restitution for grants if it is determined that the information submitted on the application is false. I have read the guidelines for financial assistance and I declare that the information furnished on this application form is true and correct to the best of my knowledge. I am 21 years of age or older and have read and understand the above statements.

First Name

Last Name

Signature of Parent/Legal Guardian

By entering your name below, you agree that the electronic printing of your name shall have the same force and effect as a written signature

Date

YYYY

Step 3: Submit Documents

To fully evaluate the application, email or mail the following required documents to The Arya Foundation before December 1:

Invoice from the provider (if not available to purchase online)
Child’s Photo
Child’s Story

Send the documents via email, we don’t have any FAX. Have questions?

Step 4: Application Review

The holiday toy application decision will be communicated by December 1.

If approved:

The adaptive toy will either be shipped directly to the family, or a check made out to the provider will be sent to the family, depending on the specific toy.
The child’s story and photo may be posted and used for The Arya Foundation’s advertising if a media release form is signed

Holiday Adaptive Toys