Oregon Center for Children and Youth with Special Health Needs 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the requestor's name, phone number, email, title, cell number, and organization. This information is crucial for processing your application.
3. Fill in the child's details including their name, diagnosis, birthdate, and county. Ensure accuracy as this information is vital for eligibility.
4. Provide the parent/guardian's name and shipping address (no P.O. Boxes). Include their contact information for any follow-up.
5. Attach supporting documentation that explains the child’s need for equipment in relation to their education. This is essential for justifying the request.
6. Indicate financial need by checking all applicable boxes under 'Justification of Financial Need'.
7. Complete the insurance information section to clarify coverage status and other funding sources.
8. List the products requested with vendor details. Be specific about each item and ensure you attach any necessary documentation from websites.
9. Review all entries for accuracy before signing. Both requestor and parent/guardian signatures are required.

Start using our platform today to streamline your application process!