"What I Wish For My Child" Request

Apply By April 30, 5pm.  Tell us your custom "wish" for a child with special needs (ages 2-21) to live and play more independently.  (We also welcome referrals from educators, social workers, & medical professionals).  Our volunteer engineers work hand-in-hand with medical professionals to make dreams come true!  Five winners will be selected in July for a FREE custom solution.  All other requests become part of our year-round Custom AT Program. 

Your Name *
Your Name
Family's Address *
Family's Address
Child's Name *
Child's Name
Contact's Phone Number *
Contact's Phone Number
Parent Name (if different) *
Parent Name (if different)
Child's Date of Birth *
Child's Date of Birth
How did you hear about us? *