Family needs & interest form

Tell us what barrier your child is facing and what could help.

Start with the practical need. Submission does not guarantee eligibility, approval, funding, timing, or a particular vendor or solution.

Family interest form is open

Tell us about the experience your child wants to join. Beyond the Pavement is gathering inclusion needs while programs and partnerships are being developed. This is an interest form, not a promise of assistance or funding.

Before you submit

Keep the first request simple.

Do not send full medical records, Social Security numbers, insurance IDs, payment information, genetic reports, or other highly sensitive documents through this form. If supporting documentation becomes necessary, Beyond the Pavement will provide a separate approved process.

What to includeParent or guardian contact information, child’s first name or initials, the mobility/access barrier, proposed solution, approximate cost or quote status, and other funding sources pursued.

Parent / guardian name

Child’s first name or initials

Experience category

What barrier is making participation difficult right now?

What experience or opportunity would your child like to join, and what could help make it possible?

Location, timing, or planning details

Partners or community resources already contacted

Date or time-sensitive circumstance

I understand this is an inclusion interest form, not a request for medical care or general equipment funding, and I will not submit full medical records, Social Security numbers, insurance identification numbers, payment information, or other highly sensitive records here.