Technology Grant | Jake's Help From Heaven

Jake’s Help From Heaven Technology Grant Program

Jake’s Help From Heaven was founded in 2011 by Jake’s parents, Brian and Heather Straughter. Jake Alexander Straughter earned his angel wings on December 8, 2010. Jake was born on May 4, 2006, a healthy, vibrant baby boy. He suffered a seizure at 8 months old and this began his very complicated medical journey. Jake never received an official diagnosis for his illness – although at the time of his passing it was thought that he had a type of leukodystrophy, a group of disorders characterized by progressive degeneration of the white matter of the brain. Through his short life, he battled epilepsy, liver disease, osteopenia, femur fractures, hip dislocation and more. He faced each hurdle with strength and courage and taught those around him how to persevere.

Through this grant program, we hope to alleviate some of the financial challenges faced by those with illnesses and their families. We understand first-hand the many challenges (expected and unexpected) that arise, and our aim is to alleviate some of the hardships.

Grant Eligibility: Grants are limited to medically fragile special needs individuals living within 100 miles of Saratoga Springs, New York.

Grant Criteria:

Grants will be awarded for technology devices, such as but not limited to tablet devices and software applications and the Board of Directors will also determine the minimum requirements for the technology device being requested.
Due to the abundance of grant requests for technology devices, the Board of Directors may only award a total of five grants per quarter.
Grants will be awarded either as reimbursement for purchase (if deemed appropriate) or paid directly to vendor.

Jake’s Help From Heaven Technology Grant Program

Section A: Personal Information

This technology request is for(Required)

EDUCATION/COMMUNICATION

QUALITY OF LIFE.

Applicant(Required)

First Last

Age(Required)

Parent/Guardian’s Name:(Required)

Enter N/A if not applicable.

First Last

Address(Required)

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

Daytime Phone Number(Required)

Evening Phone Number

Email(Required)

Describe your medical diagnosis and how it relates to a technology need.(Required)

Describe what other assistive technology devices, if any (PECS, Go Talk, Dynavox, etc) have already been used and to what level of success.(Required)

How do you expect to use this device if obtained?(Required)

Explain how you think this device will contribute to (as applicable) the applicant’s ability to communicate/participate in education; or an increased quality of life for the applicant(Required)

Grant amount requested:(Required)

List the item(s) you are seeking funding or reimbursement.(Required)

Parent(s) name printed(Required)

First Last

Parent(s) signature:(Required)

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)

First Last

File

Max. file size: 2 MB.

Pediatrician/primary care doctor/social worker signature:

Pediatrician/primary care doctor/social worker contact phone number or email:(Required)

Date

Name

This field is for validation purposes and should be left unchanged.