Welcome to the Golden Halo Foundation. In order to be considered for funding, we ask that you complete the form below. Before completing the form, we suggest you scan your various documents as you will be asked to upload them as a part of your application. Here is a list of documents that will need:

• Letters from physician and/or PT, OT or SLP that includes the recommendation for request and benefits of the request for the child
• Official receipts/invoice/estimate on procedure or equipment requested, if a discount is available, and name and address of third party who will receive payment.
• Letter of denial from insurance or Medicaid, if applicable. If not applicable, please check anyway.
• HIPAA Authorization Form (you can download this form here and you will need to sign it then scan in order to upload.)
• Child’s Photo
• Golden Halo Foundation Photo Release (you can download this form here and you will need to sign it then scan in order to upload.)