Take a Bite, Change a Life

Application for Funding

CONTACT INFORMATION


Name:
Address:
City:
Province:
Phone:
Mobile:
Email:

 

Once we receive your information, you will be contacted by an Aaron’s Apple representative. The following information will be required at that time:
 

  • – Name and Age of Child
  • – Diagnosis of Child
  • – Letter from your Child’s Doctor/Nurse stating the medication that is required.
  • – Proof of family income (i.e. T4, Tax return/assessment, pay stubs, etc.)

 
You will also require one of the following:
A letter from your private insurance company stating whether or not this medication is covered, and if yes, how much is covered. OR A letter from the Ontario Trillium Foundation (http://www.drugcoverage.ca/p_benefit_on.asp) stating whether or not this drug is covered, and if yes, how much is covered.
 
Our fax number is 416-628-1597 and should read “Attention: Aaron’s Apple”.
 
Please note: If you are unable to obtain either of the above listed items, it will not invalidate your application. Aaron’s Apple will still work with you to ensure your child’s medical needs are met. By providing all of the above information it will allow us to ensure our support goes to those most in need and helps us obtain a proper assessment of your situation. Not providing this information, or providing false information may delay your application.