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Accessibility Supports Equipment Loan Program Application

Accessibility Supports Equipment Loan Program Application Please submit applications to Easter Seals Alberta | P: | F: | 103, 811 Manning Rd. NE Calgary AB T2E 7L4 Page 1 of 10 Client Equipment Funding Request Form Thank you for your interest in applying to the Easter Seals Alberta Equipment Loan Program . Easter Seals Alberta is an organization dedicated to supporting Albertans living with physical, cognitive, and/or medical disabilities, and our mission is to provide services that foster inclusion, independence, and recreation for our clients. This Program is intended to be a funding option for individuals who have exhausted all other funding resources for Accessibility Equipment . Equipment that is eligible for funding includes: power mobility devices ( scooters, power wheelchairs), lifts ( vertical lifts, porch lifts, stair lifts, etc.)

AISH Alberta Works (Income Support) Other Income This could include; private insurance, long term disability, student loans, rentals, Health and W elfare Canada, investment income, EI , child maintenance, WCB, CPP, GIA, Alberta seniors benefit, old age pension, DVA, trust funds or anything else. Please itemize your other income below .

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