Robbie Memorial Fund – Application Form – Adult Assessment

Purpose

The Robbie Shuttleworth Memorial Fund has been created by the Learning Disabilities Association of Toronto District to provide funding for parents or guardians of children or adults themselves who require an Assessment.

Learning Disabilities Association of Toronto District

Serving the amalgamated City of Toronto, the Learning Disabilities Association of Toronto District (LDATD) is committed to the development of a community in which persons with Learning Disabilities (LDs) are enabled to successfully realize their full potential of their intellect and abilities. The LDATD’s mission is to act as a centre of excellence in the provision of education, advocacy, research and services to advance the full participation of children, youth, and adults with LDs in Toronto.

The Robbie Shuttleworth Memorial Fund is a critical element to LDATD in realizing this mission.

Do I Qualify for Funding?

“Learning Disabilities” refers to a variety of disorders that affect the acquisition, retention, understanding, organization or use of verbal and/or non-verbal information. These disorders result from impairments in one or more psychological processes related to learning, in combination with otherwise average abilities essential for thinking and reasoning. LDs are specific, not global impairments, and as such are distinct from intellectual disabilities.
To correctly understand if there is a Learning Disability at play in a person’s learning, a proper assessment must be conducted. This assessment can only be done by a qualified practitioner. Many times, the schools boards will provide this service free of charge however, the waitlist for service can be long and the need can be great. Therefore, many parents and adults turn to private practitioners for quicker answers. This can be costly.

If an adult requires an assessment and financial assistance in retaining an assessment, the Robbie Shuttleworth Fund has been created to help.

Funding criteria have been established to evaluate requests submitted in an equitable and efficient
manner. However, priority will be given to families unable to afford participation and/or have children currently on the waiting list for the TDSB/TCDSB psychologist. Please submit a completed application form to the Learning Disabilities Association Toronto District, 121 Willowdale Ave. Suite 103, Toronto, Ontario, M2N 6A3, call 416.229.1680, email to [email protected] or fax to 416.229.1681.

Note: The application must be completed in full. Only completed applications with the requested documentation will be considered. Incomplete applications will be returned unprocessed.

Eligibility Criteria (Please read carefully)

Applicants for the Robbie Shuttleworth Memorial Fund must be a City of Toronto resident.
The adult undergoing the assessment must be over 18 years of age.
The Applicant/family is encouraged to volunteer and support the LDATD.
The Fund is meant to support families who are unable to afford to pay for the assessment due to financial constraints. Constraints that are either prohibiting or significantly hampering the Applicant’s financial wherewithal to afford an assessment should be described in detail.
Provide documentation confirming that the household gross income of the adult applicant and their respective spouse / common law partner.
There is a maximum of one grant to any one individual lifetime. Priority will be given to first time Applicants as well as those Applicants who are currently on wait lists for psychological assessments.
Groups may apply on behalf of individuals within their organization.
Although the LDATD Board of Directors will consider exceptions, a maximum grant up to $1800.00 for an individual will be considered.
Applicants must provide an invoice or estimate (verification of amount that assessment will cost) with their application for each recipient. Once an application is approved, payment will be made to the organization/vendor that provided an invoice. Reimbursements are not part of this funding program.

Note: While the eligibility criteria and applications forms below have been developed as guidelines. Unique circumstances will be considered by the Board of Directors on an individual basis.

Application

All groups or individuals applying for a grant must provide a completed grant application.

Administration

The Board of Directors will review all applications and the Board of Director’s decision is final. Distribution of funds will be through the LDATD Board of Directors executive council and the Executive Director.

Applicant Information

Name of Adult Applicant

Name of person filling out the form if different from above, and relationship to Applicant

Address

Street Address Address Line 2 City Province Postal Code

Phone

Funding Request and Rationale

Total Funds Requested

What financial constraint(s) do you have that require(s) you to seek financial assistance?

What would receiving this funding mean to you?

Did you receive or are you requesting funding from any other organizations, groups or agencies?

Yes

If yes, from whom and how much did you receive?

LD Assessment Information

Describe why you feel you are in need of a special assessment.

Has an assessment been recommended by your school or employer? Why? Why not?

Name of organization/practitioner performing the assessment

Are you currently on a waiting list to receive an assessment?

If yes, how long has you been waiting?

Have you ever received a LD Assessment prior to 2015?

Other Information

Have you received funding from the Robbie Shuttleworth Memorial Fund before?

If yes to above, when were the funds paid out?

Amount Received

Date Received

The application acknowledges that if funding is provided, an evaluation of the success of the funding will be required.

Certification

I certify that the information provided in this application is true, correct and complete to the best of my ability and the LD assessment has not been conducted.

Please review the application form to ensure all information and supporting documentation is provided.
If any information is missing, the application will be returned for completion, resulting in a delay in processing your request.
Ensure to keep a copy for your records.

Robbie Memorial Fund – Application Form – Program Subsidy

Robbie Memorial Fund – Application Form – Child/Youth Assessment