Join Evie Application Form

Join Evie Adapts Today

Please review the information below before applying.

Grant/Services Eligibility

Must have a documented disability diagnosis.
Your place of residence must be a Florida state address.
Age of applicant must be 35 yrs. of age or younger.
Have financial need, indicated by financial documents and/or extenuating circumstances.
The requested equipment, service or remodel must be directly related to the child’s disability treatment.
If you have health insurance, you are still eligible.

Evie Adapts helps kids gain access to:

Therapies: ABA, OT, PT, speech, service animals, etc
Therapeutic Equipment: iPads, laptops, swings, weighted blankets, sensory items, items to increase social and life skills etc.
Safety Equipment: Personal & home safety, etc.
Services: Swim, music, horse riding lessons, etc.
Camps: Summer, social and specialty, etc.

Additional Information

Preference will be given to families showing financial need. Extenuating circumstances are considered.
Items not covered by Evie Adapts include: Respite, diagnostic appointments, travel, reimbursements, gift cards, medication not administered by a physician, or for past due services that you are no longer receiving.
Once your application is received and processed, you will be notified via email.
If complete, your application will be sent for review at the next Evie Adapts Board meeting. You will be contacted via email of a decision. Please allow an estimated 45-60 days to process your complete application.
If incomplete, we will contact you for required documentation. If not completed by 6 months, the application will expire and you will need to fully reapply.
Further documentation may be requested and submitting an application does not guarantee an award.
If eligible, you may be awarded once every 12 months from date of previous award.
If awarded, funds will go directly to the service provider, vendor, retailer or organization listed on the application. Funds will not be paid directly to the family. Once awarded your request cannot change.

Apply Now

Fill out the application below, once your application is received and processed, you will be notified via email.

"*" indicates required fields

Child's Name*

Date*

Guardian Name*

Child's Age / DOB*

Phone*

Email Address*

Florida Address*

Street Address Address Line 2 City ZIP Code

Description of Need*

Is the applicant a previous Evie Adapts recipient?*

Yes

When was the last award date?*

Amount Requesting:*

Please describe the specific request, i.e. equipment or therapy and assign a dollar value to that request.

Do you give permission for media coverage?*

Yes

Family Story*

Please list all members of the household*

Please list all members who work*

Please list all guardians if more than 1*

Disability Diagnosis*

A copy of the applicant’s official disability diagnosis or a signed letter from a MD. or ARNP.

Accepted file types: jpg, jpeg, png, heic, pdf, Max. file size: 5 MB.

Financial Document (1040)*

A copy of your current 1040 (tax return) must list a child as a dependent and gross adjusted income. SSI Document is accepted if you did not file taxes.

Accepted file types: jpg, jpeg, png, heic, pdf, Max. file size: 5 MB.

Referral Letter*

Must be signed by a Doctor, Therapist or Special Ed Teacher specifically recommending the specific request, clearly stating how it will benefit the child. Must be on service providers letterhead.

Accepted file types: jpg, jpeg, png, heic, pdf, Max. file size: 5 MB.

Applicant's Photo*

Can be a selfie or a picture with the family.

Accepted file types: jpg, jpeg, png, heic, pdf, Max. file size: 5 MB.

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