Assistive Technology Grant (ATG) Application Pack

Assistive Technology Grant Application Form

Department of Education & Skills (SEN / NCSE Circular 0010-2013 (DES Assistive Tech Scheme))

We fill out the grant form FOR YOU! Complete the sections below with the student's details, school information, and therapist recommendation. TapTalk AAC will automatically compile your official Department of Education Assistive Technology Grant (ATG-100) Pack ready for submission.

1 Student & School Information

Student Full Name

Date of Birth

PPSN (Personal Public Service No.)

School Name

School Roll Number

Class / Year Group

School Address

School Email / Contact

2 Parent / Guardian Contact Details

Parent / Guardian Full Name

Phone Number

Email Address

Entering your Eircode automatically fills in your Home Address.

Eircode Autofills

Home Address

Relationship to Student

3 Special Educational Need (SEN) & Clinical Recommendation

Primary Diagnosis / SEN Need

Recommending Specialist (SLT / OT)

CORU Registration / License No.

Clinic / CDNT (Disability Team)

Date of Assessment / Report

Functional Communication Rationale (How TapTalk AAC helps the student in school)

4 Equipment Specification & Official Quotation

Selected AAC Device Suite Package

Total Grant Quotation (€)

€

Official Quote Reference

Included Accessories & Software

5 Parent Declaration & Signature

I hereby confirm that the information provided above is accurate and complete, and I authorize TapTalk AAC and the school SENCO to compile and submit this Assistive Technology Grant (ATG) application to the Department of Education & Skills / NCSE on behalf of my child.

Digital Signature (Draw inside box below)

I agree to the terms and authorize TapTalk AAC to generate the official ATG Application Pack.

Department of Education & Skills — Ireland

Assistive Technology Grant (ATG-100) Official Application Pack

NCSE Circular 0010-2013 (DES Assistive Tech Scheme) & Department Circular 0064/2020

1. STUDENT & SCHOOL DETAILS
Student Full Name:
Date of Birth:
PPSN:
School Name & Roll No:
Class / Year Group:
2. PARENT / GUARDIAN DETAILS
Parent Name & Relationship:
Contact Phone & Email:
Home Address & Eircode:
3. CLINICAL RECOMMENDATION & SEN DIAGNOSIS
Primary SEN Need / Diagnosis:
Recommending Specialist (SLT/OT):
Assessment Rationale:
4. RECOMMENDED EQUIPMENT & QUOTATION
Equipment Suite Package:
Total Grant Quotation (€):
Official Supplier:	TapTalk Ireland / AAC TapTalk (Ref: )

5. PARENT / GUARDIAN DECLARATION & DIGITAL SIGNATURE

I declare that the information supplied is correct and authorize submission of this Assistive Technology Grant application.

Digital Signature:

Date Signed: