Grant Application Guidelines (Scroll Down for Application)
- Each member of the Gallaudet Fund Committee shall assist the chairperson in dispensing grants to needy deaf and hard of hearing residents of new York State, aged 55 years and older. The chairperson shall be responsible for this program.
- The member shall identify the applicant as residing in its area through individual contacts or through organizations serving these individuals and assess any special needs they may have.
- A deaf or hard of hearing resident is defined as one with financial needs and without alternative means of meeting that needs, shall file an application for a grant.
i. Medical:
a. wheelchair (Receipt requested)
b. cane (Receipt requested)
c. walker (Receipt requested)
ii. Assistive Devices
a. #710000500 Minicom IV – Teletypewriter (TTY)
b. #P/100 Doorbell and/or Telephone ringing light
c. #P/GEN710L Smoke Alarm
d. #P/SACOMBO Sonic Boom Clock and Vibrator
e. Hearing Aid (Receipt must be furnished from Qualified Dealer
($500 Maximum)
f. Door Knocker (Simplicity Brand)
g. Raised toilet seat
h. Communication Devices
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iii. Recreational:
a. Elder camp (Camp Mark Seven). (Receipt requested)
b. Elder hostel (Receipt requested)
c. Continuing education in arts, crafts and retirement planning.
(Receipt requested)
d. ESAD Conference Combo ticket (Receipt requested)
- Any equipment provided to the recipient shall be returned to the sponsoring committee when and if the recipient demonstrates no further need for it. A label showing the name of the committee and its address and/or TTY number shall be affixed to the equipment. The chairperson shall furnish the labels.
- Grants shall be limited to economic need of the deaf or hard of hearing individual. Receipts or Invoices shall be needed for some devices if purchased by individual.
- Each applicant is limited to one grant application per year.
- The chairperson and the committee will review the application if the applicant orders more than one device.
Gallaudet Fund Grant Application Form
This is an application for a grant to satisfy economic need for a deaf or hard of hearing resident of the State of New York, 55 years of age and older, whose needs cannot be provided by alternative means. The applicant must demonstrate ability from this support. The completion of this application must fully adhere to the guidelines established by the Gallaudet Fund Committee. All pertinent information is confidential.
Applicant’s income shall be up to $2,000.00 per month.
Name of Applicant:____________________________________
Name of Person filling out this application if different from above: ___________________________________________________
Date of Birth: _____________________
Address:____________________________________________
City/State/Zip Code:____________________________________
Social Security Number: ________________________________
Please provide a copy of last year’s Federal 1040 form:_________
Total adjusted federal income
List item(s) you need from the three basic categories that you need and explain why:
____________________________________________________
____________________________________________________
____________________________________________________
_________________________________
Signature of Applicant:__________________________________
Committee Member:____________________________________
Comments:___________________________________________
Send this form to:
Paula Wollenhaupt
Chairperson of Gallaudet Fund
54 Thorndyke Road
Rochester, New York 14617-3802