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Login Name

Password

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Child's Full Name

Your Relationship to Child * Parent Guardian Grandparent Other

Child's Date of Birth

Do they have a confirmed diagnosis of Down syndrome? *

If yes, please upload any documentation confirming the diagnosis.

Optional: Provide any additional relevant medical details (e.g., co-occurring conditions)

Type of Assistance Requested (Select one or both) *

If you have a link to the specific equipment or therapeutic service you are requesting, please provide that here:

Please provide details about the item(s) or services needed (e.g., specific medical equipment, therapy type, etc.)

If applicable, please upload a letter or statement from a healthcare provider recommending the requested equipment/service.

How will this equipment benefit your child? *

Is this request urgent? *

If needed urgently, please explain:

Have you previously received assistance from Team Iron Will? *

If yes, please specify the date you received it and the assistance received:

Total annual household income (choose range): * <$25,000 $25,001-$50,000 $50,001-$75,000 $75,001-$100,000 >$100,000

Please provide any of the following documentation to verify your income: Tax Return (most recent), Pay Stubs from past 2 months, Bank Statements from past 2 months (only use if other forms of income are inconsistent or non-traditional like freelance).

Total number of individuals living in the household (including yourself): *

Does your family participate in any of the following? (Check all that apply): *

If "Other" please specify:

If receiving government assistance please provide documentation to verify:

Is there anything else you’d like us to know about your situation or request?

By submitting this application, I confirm that the information provided is accurate to the best of my knowledge. I understand that completing this application does not guarantee assistance. *