Application Form

The following documents must be uploaded/included with your Application: Licensed Canadian Medical Practitioner’s Diagnosis Letter from Child’s Therapist, Medical Professional, or Social Worker supporting the application Notice of Assessment(s) – Require page with line 150 only (total income) Assistance to Children with Severe Disabilities (ACSD) stub/statement(If NO ACSD is received, a cheque stub or statement for employment…etc) If you have supporting documents, please include: Quote from vendor or supplier- if applicable

We love to receive letters and photos from the children and families that we assist. It is important for JACC to be able to communicate with our supporters and donors, what life is like for your sick child and for you as a family. We like to feature stories of children in our newsletters, letters to donors, on Facebook, Twitter and our website, and in the plaques that we present to our supporters. Please indicate below if the Jennifer Ashleigh Children’s Charity may use any photos, children’s artwork, or thank you letters that you send to us along with your child’s first name, age, and nature of their illness. This is for awareness and promotional purposes only. Be assured if your letter is used, only first names will appear. Any last names or addresses will not be used.

The Jennifer Ashleigh Children’s Charity Privacy Policy makes every effort to ensure that any individual’s personal information is protected and properly handled. The information you provide on this application is only used for the purpose of determiningRevised April 12, 2019 eligibility. It is reviewed and handled by only those designated and authorized to do so within the Jennifer Ashleigh Children’s Charity office. For a full version of our Privacy Statement please visit: www.JenAsh.org If your application is granted and a file is created, your secure file will be stored at our office location for five years (for audit purposes) before being shredded. Minimal information is also kept indefinitely on our secure database. If you have a concern or inquiry regarding our Privacy Policy or our privacy practices please call our office at (905) 852-1799 ext. 21 or email generalmail@jenash.org