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Application for the Authorization of Equipment Repair or Replacement – Youth

Form number: 1318

This form is to be used for applications relating to the September 1, 2018–August 31, 2019 award year.

You need to fill out this form if your child has already acquired a device under the Allowance for Special Needs Program and that device now needs to be repaired or replaced.

This form is only intended for students attending a private educational institution that is not accredited for preschool, elementary or secondary education subsidies.

The cost of repair or replacement is reimbursed only once in a lifetime.


  • Section 2 must be filled out by person at your child’s educational institution who is so authorized by the school administration.
  • The form must be accompanied by a quote or be signed by the merchant or authorized person from the technical assistance service.


Print and fill out the form, have your child’s attendance confirmed by an authorized person at the child’s educational institution, then sign it yourself and mail it to the address shown on the form itself.

Download the form

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