Make It Happen Benefit Application Form

Make-It-Happen Benefit Application Form

We treasure your interest in our benefit. We would love to know more about you and your story.

If granted these requests, how will you pay it forward in your community? Does not have to be a big gesture, but our goal as the Make-It-Happen benefit is to encourage others to do good to those around them. It will make the world a brighter place - let's Make It Happen!!

Please add your information below and we'll get back to you in no time!

You may only apply if you or someone you know living with an exceptionality is in need of supplies, resources, support, or other items that would benefit this individual.

After completing this application, Sharing A Purpose administration will book a home or virtual visit before processing your requests for approval.

Individual Filling Out Form Information

Name

Email

Phone Number

Relationship to Applicant

Applicant Information

Name

Birth date

YYYY

Home Phone

Cell Phone (if applicable)

Current Age

Gender Identification

E-mail (if applicable)

Home Address

Guardian(s) Information

Guardian 1: Name

Guardian 1: Phone Number

Guardian 1: E-mail

Home Address of Guardian 1

Guardian 2: Name

Guardian 2: Phone Number

Guardian 2: E-mail

Home Address of Guardian 2

Medical Information

Medical Diagnosis

Year Of Diagnosis

Physician's Name

Physician's Office Address

Make-It-Happen Benefit

Has the applicant applied to the Make-It-Happen Benefit in the last year?

Yes

Has the applicant applied to any other benefit or organization for requests before?

Yes

If so, where did they apply?
If not, please put N/A (not applicable)

Please list all current funding & amount applicant receives (i.e. ODSP, Passport, RSA, SSAH, etc.).

Your Story

Please explain what your request is for Sharing A Purpose. We will try to Make It Happen to the best of our abilities!

Please share at least 1 reference that is from the educational, health or medical field (i.e. OT, PT, doctor, nurse, etc.) that we may be able to contact.

Benefit Details

How did you learn about our benefit or organization?

A Friend or Colleague

Website

Online Ad

Social Media

Blog Post

Agency

News Article

DSO

Other:

Benefit rules

I have read, understood, and accepted the rules of the benefit

Verification

Never submit sensitive information such as passwords. Report abuse

Create online forms and surveys