Make A Request

Help A Little One Foundation - Request a Gift

Please complete this form and submit it online

Date of Completion:

Recipient Information:

Name:

Date of Birth:

Full Address (Street, City, State):

Description/severity of neurological impairment:

Gift requested:

Requester Information:

Name:

Relationship to intended recipient:

Full Address (Street, City, State):

Email Address:

Telephone:

Ext:

Mobile number:

Name/address of any matching funder(s):

Additional document(s):

Select file(s) to upload: (Only .pdf and .jpg files may be upload. You can upload multiple files by click and hold the CTRL (PC) or Command (MAC) buttons and select the files. Be sure all the files you wish to upload are in the same location/folder.)

The Help A Little One (H.A.L.O.) Foundation will consider requests from nursing homes, families, guardians, professionals and community and social service agencies. Recently approved requests include: Adaptive tricycles, wheelchair lifts, computer equipment, transportation for special excursions, enrichment programs, support for community events, nursing home outings, technology for individual growth and/or communication and/or management of an individual’s disability, and support services to families caring for a child with neurological impairment at home. H.A.L.O. does not fund building maintenance, hospital equipment or medical treatment, or other expenses covered by insurance and public health, welfare and social service agencies. Address any questions to info@halo.org

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Make A Request

Help A Little One Foundation - Request a Gift

Please complete this form and submit it online

Recipient Information:

Requester Information:

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