Physician’s Certification of Medical Condition
One of the required documents that we must receive with your child’s application is a certification from your child’s physician of the medical condition(s) relating to the items you are seeking assistance.
Please review and follow the guidelines below to complete this requirement.
- Download and print a copy of the Physician’s Certification of Medical Condition Form.
- Complete the top portion of form and provide to your child’s physician to complete the bottom portion.
- The form MUST be completed and signed by an M.D. (Doctor of Medicine), D.O. (Doctor of Osteopathic Medicine), or for hearing-relating conditions, an Au.D. (Doctor of Audiology) within the last 6 months.
- After you receive the completed form back from your child’s physician, please scan a copy to your computer (you may also take a picture of each side) and attach it to your child’s grant application when submitting online.