Application For Assistance

  • Suzy Foundation is passionate about helping children with special needs achieve their D.R.E.A.M.S.

    Please complete the entire application below and attach the necessary documents. For a pdf version of the application, please click here.

    To Qualify:

        Child must be 17 years old or younger
        Include a letter or prescription from the applicant’s doctor confirming the need for the requested assistive device or therapy.
        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.
        Letter of denial from parent(s)/guardian(s) insurance company.
        Your application will be valid one year from its submission date.
        Incomplete applications will not be accepted. If denied, Suzy Foundation will review your application throughout the year.
        Suzy Foundation considers each applicant on an individual basis.
        Please mail completed application to Suzy Foundation, P.O. BOX 24877, Tempe, AZ 85285
        Must live in the Phoenix/metropolitan area

    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 enter a value between 0 and 99.
  • *If your child receives OT, PT, or speech therapy, and the device or service you are requesting will improve his or her progress within that therapy: Please attach a letter from your child’s therapist detailing your child’s current limitations and progress.*

  • **If not covered by your insurance, please attach an official letter of denial from your insurance provider.**
  • Person to contact if selected: Parents/Guardians
  • Drop files here or
    Accepted file types: jpg, doc, docx, pdf.
    Upload any additional materials. Accepted file types are jpg, pdf, doc, docx.
  • *If you cannot upload the necessary files please mail them to:
    Suzy Foundation
    P.O. Box 24877
    Tempe, AZ 85285