info@jakeshelpfromheaven.org

Jake’s Help from Heaven Technology Application

Jake’s Help From Heaven welcomes applicants of all ages living within 100 miles of Saratoga Springs, NY.

For those applying for technology devices, including but not limited to tablet devices and software applications, please use the following application:

JHFH TECH APP 2024

IF YOU ARE A REPEAT APPLICANT, PLEASE USE THE TECHNOLOGY APPLICATION NOT THE REPEAT APPLICATION.

Apply Online

Grant Eligibility:
• Grants are limited to individuals living within 100 miles of Saratoga Springs, New York.
• Grants are restricted to individuals with complex medical needs and disabilities resulting from
congenital or childhood-onset diseases. Applicants of all ages with lifelong, debilitating illnesses
are welcome to apply.

AS OF 2024, INCOMPLETE APPLICATIONS WILL NOT BE SUBMITTED TO THE BOARD OF
DIRECTORS FOR CONSIDERATION. THE FOLLOWING CRITERIA MUST BE MET:

• Specify if the technology device will be used for education/communication or quality of life
purposes.
• Completion of the following application with the signature of a pediatrician/primary care doctor
or social worker.
• A doctor’s prescription and/or a professional letter of medical necessity by a doctor, therapist, or
teacher. The letters of medical necessity must be signed and dated, preferably on letterhead.
• Proof of payment is required for reimbursement or vendor information for direct purchase. We
do not award money for general donations or support.
• To be eligible for reimbursement, items must have been purchased within one year of the date
that the application is being reviewed.
• Applicants should submit their completed applications and required documents all at once.
• Electronic applications must be submitted in PDF format, not jpegs or screenshots.
• There is a $2,500 cap per applicant per calendar year. Applicants may apply multiple times
within a calendar year but are only eligible to be awarded a total of $2,500 within that year.
• All iPads include AppleCare protection plans. It is the applicant’s responsibility to contact
AppleCare directly in the event of any damage to the product. JHFH will not consider replacing
iPads within two years of the original purchase date.
• If you receive your requested item elsewhere, please alert us immediately so we can withdraw
your application. Failure to do so may affect your eligibility to apply in the future.

IN ADDITION, PLEASE NOTE THE FOLLOWING POLICY CHANGES:

• Please be precise when providing product information. JHFH is not responsible for
returning/exchanging incorrect items that resulted from a mistaken request.
• Please double-check that the applicant’s address is listed correctly. JHFH is not responsible for
replacing items mailed to the wrong address due to errors on the application.
• Applicants requesting a grant of over $1,000 may be asked to submit a current income tax return
or other financial information.
• When individuals other than the applicant are completing the application, please write in the
third person and do not write in the applicant’s voice.

Jake’s Help From Heaven Technology Grant Program 2024

Section A: Personal Information

Applicant(Required)
Parent/Guardian’s Name:(Required)
Enter N/A if not applicable.
Address(Required)

Contact information for the individual completing the application (if different from applicant/guardian)

Name

Section B: Application Details

Which type of payment are you seeking? Check one
Check one. This technology will be used mainly for

A doctor's prescription and/or letter of medical necessity is REQUIRED. You may upload your documents here or mail your documents in.

Drop files here or
Accepted file types: jpg, pdf, Max. file size: 2 MB.

    Receipts of purchased items OR vendor information for item to be paid directly by Jake's Help from Heaven is REQUIRED. You may upload your documents here or mail your documents in.

    Drop files here or
    Accepted file types: jpg, pdf, Max. file size: 2 MB.

      Section C: Disclosure/Signature

      Parent(s) name printed(Required)
      MM slash DD slash YYYY

      You may upload a photo or a scan of a signed document from your doctor with the endorsement saying "I (social worker or primary doctor) support (applicants name) application for (requested item) on (date)” or use the save and continue option and send your social worker or primary doctor the link for them to sign. After adding their signature, your doctor or social worker must then use the save and continue option and send you the new link to your form.

      Pediatrician/primary care doctor/social worker name printed(Required)
      Max. file size: 2 MB.
      MM slash DD slash YYYY
      This field is for validation purposes and should be left unchanged.