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Use black ink only.ATF Utah Assistive Technology Foundation Small Grant Application Referred by: 1. Applicants Name 2. Home Address City State Zip Code Telephone Email 3. Date of Birth 4. Race/Ethnicity
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How to fill out person wdisability if different
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To fill out a person with disability form if different, follow these steps:
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Begin by providing the personal details of the person with a disability, including their name, date of birth, and any identification number or reference.
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If relevant, describe any assistive devices or technologies that the person uses to aid their mobility, communication, or other activities.
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Detail any specific accommodations or support that the person requires in order to participate fully in education, employment, or other aspects of life.
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If applicable, provide information about any healthcare professionals or institutions that are involved in the person's care or treatment.
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