Robbie Memorial Fund – Application Form – Program Subsidy

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 who could benefit from the programming but cannot afford the service fees.

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 the 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.

Funding criteria have been established to evaluate requests submitted in an equitable and efficient
manner. 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 residents of the City of Toronto resident.
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 programming due to financial constraints. Constraints that are either prohibiting or significantly hampering the Applicant’s financial ability to afford the program fees should be described in detail.
Documentation confirming the household gross income of the child’s parent(s)/guardian(s) and their respective spouse / common law partner must be submitted.
A maximum grant up to $700 per family per year will be considered.

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.

Subsidies for Programming – Application Form

Complete the following form and submit proof of family income for the previous year. Acceptable forms of proof of income:

Previous Year’s Financial Notice (Notice of Assessment from CRA)
T4’s
Financial Letters(from OW; ODSP; Service Canada; EI)

Applicant Information

Name of Parent(s)/Guardian(s)

Name of Child/Youth/Adult

Marital Status

Number of Dependents

Address

Street Address Address Line 2 City Province Postal Code

Phone

Funding Request and Rationale

Total Funds Requested

Max $700 per year

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 Information

Has your child been formally diagnosed with an LD or AD(H)D?

Please specify

Describe the difficulties your child is having due to their Learning

Disability/AD(H)D:

Describe why you feel your child is in need of our programming:

How did you hear about our program?

If you were referred, please include the name of person and organization recommending the program

Is your child currently on a waiting list to participate in programs elsewhere?

Other Information

If you are not the parent or guardian of the child listed above (e.g. social worker, teacher), is the parent/guardian aware you have made this application on behalf of the child?

If no to above, please explain why not:

Has the child listed above 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 – Adult Assessment

Robbie Memorial Fund – Application Form – Child/Youth Assessment