Please note: This grant program provides full funding for devices valued at $500 or less, and partial funding for devices exceeding $500.

Questions? Contact technology@albinism.org.

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* 1. Did you participate live or review the recording of NOAH's Technology Assistance Demo Webinar? NOAH strongly recommends reviewing this resource prior to application.

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* 2. The person completing this application is:

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* 3. Name of individual, parent and/or vision professional filling out the application

While a vision professional's recommendation is not required, all applicants are strongly encouraged to include one, and applications supported by a recommendation will be given preference. Recommendations should be submitted at https://www.surveymonkey.com/r/NOAH-Ipad-recommendation by the application deadline. Questions should be directed to technology@albinism.org.

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* 4. Applicant Contact Information

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* 5. Are you in NOAH's contact database?

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* 6. Applicant Date of Birth

Date

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* 7. Does the applicant have albinism?

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