How to Apply for Equipment

For Power Mobility (including power wheelchair and scooters) complete and submit the following forms:

• Application for Equipment (Print version) or Application Form for Equipment (Fillable pdf Form)
• Occupational/Physiotherapist Assessment for Power Mobility
• Medical Report Form for Power Mobility

For Other Equipment (including communication aids, vehicle adaptations or home adaptations) complete and submit the following forms:

• Application for Equipment (Print version) or Application Form for Equipment (Fillable pdf Form)
• A letter from your physician indicating your disability and recommendation/prescription for equipment.

All applicants must include their household Income Tax Notice of Assessment from two years prior.

Please Note: Due to numerous requests and the ongoing shortage of available funding an extended waiting period is often required to raise larger sums of money.

* Information provided is confidential and used only for the purpose it was intended.

We appreciate hearing about how this equipment made a difference in your life. Please send us pictures and/or letters. In order to share your story, please print and fill out a Release of Information for Publicity Form, and return it to Easter Seals Alberta.

 

Criteria for Funding

Applications for funding assistance are available by calling one of our Easter Seal offices. Once the application is received a caseworker meets you to clarify and obtain further information.

Each request is assessed under the following criteria:

1. Physical need for the equipment. Provide supporting documentation such as:
   
   • a doctor’s prescription
   • a physical or occupational therapist assessment
   • a letter of support from another appropriate professional.
2. Financial need for assistance. Each applicant must complete the financial section on our application. Due to the numerous requests we receive and the ongoing shortage of available funding, priority must be given to those with the greatest need.

All requests received are screened carefully for urgency and necessity.

Funding assistance is available through the following options:

1. Interest free loan for the total cost of the equipment
2. Cost sharing by the client or another funding source and Easter Seals
3. Grant for the entire cost of the equipment.

Funding organizations generally grant Easter Seals Alberta ownership of the equipment. We then loan it to the individual on a long-term basis. This system allows us to recycle the equipment to someone else when the initial client no longer requires it. 

If Easter Seals Alberta contributes 51% or more of the cost of equipment, we retain ownership of the equipment.

Easter Seals Alberta does not reimburse for equipment purchased nor become involved with requests after equipment is ordered.

Recipients are responsible for repairs and maintenance while using supplied equipment.

If you require further information about our Equipment & Support Services, please contact us.

Red Deer and North:
1408, 10025 106 Street
Edmonton AB T5J 1G4
Phone: (780) 429-0137
Fax: (780) 429-1937

Email: Edcchd%21Mhruds

South of Red Deer:
103 - 811 Manning Road NE
Calgary AB
T2E 7L4
Phone: (403) 235-5662
Fax: (403) 248-1716

Email: Uidsdr%60%21ed%21V%60%60m