To Qualify YOU MUST:
- Include a letter or prescription from the applicant’s doctor confirming the need for the requested assistive device or therapy.
- Include a copy of parent(s)/guardian(s) most recent Income Tax Return (IRS Form 1040) with copies of all supporting W-2 forms. For your security all information is confidential and treated with the utmost sensitivity. Please black out your social security number. All documents will be shredded once a decision has been made.
- Include a letter of denial from parent(s)/guardian(s)
- Live within Arizona
Please be advised that the Suzy Foundation will directly purchase the assistive device or therapy for the applicant. Suzy Foundation will NOT reimburse services rendered or devices previously purchased. Please include all of the necessary purchasing information. Please use the form below to apply for Suzy Foundation assistance. Once you complete the form, you can upload your application files here. Please label your folder with YourName_Date and zip all files before you upload. If you need technical assistance please call us or send us an email.
Please label your files with the name of the Applicant and the Document Name : Example – prescription would be labeled: ApplicantName_Prescription.doc