Funding Equipment Worksheet

Equipment Needs

What equipment is needed?

When will it be needed? (present or future needs)

Is there funding available?

What are our priorities right now?


Questions to start considering?

  • What are the ways that this equipment is paid for?
  • Will we need a prescription for this equipment?
  • Will we need a letter of support for this equipment?
  • Will we need the funding approved before we can order?
  • Will we need a quote(s) when applying for funding?
  • What will the timeline look like (e.g., fund, order, receive, fit)?
  • Who needs to be involved (e.g., clinician, vendor)?

Equipment Vendor (store):

Contact Name and Phone/Email:

TVCC Clinician:

Contact Name and Phone/Email:


See Also:

TVCC Funding Guide
TVCC Funding 101 Handout
TVCC Funding Equipment Handout for Families

PDF Format of Funding Equipment Worksheet