A. Eligibility Requirements

Applicants must answer yes to the following questions to be considered eligible:

1. Is your child a Kindergarten to Grade 11 student? *
2. Do you have a child with a learning disability? *
3. Does your need fall within any programs and services that may include, but not limited to, supporting the costs of attending a summer camp, social skill development courses, tutoring, assessments, and technology. *Note: sports programs and/or private school tuition does not quality. *
4. Will your child access this program or service within 2025? *
5. Is your child a resident of Alberta? *

* Only one application per family.

B. Parent/Guardian Information

C. Child’s Information

Please specify the primary area(s) of your child(ren)’s learning disability:

D. Purpose of Funding

Your Request

Select what the funds will be used for. Please choose one:

E. Short Answer Questions (limit answers to 150 words per question)

Based on your request checked above:

IMPACTS

FUNDING

1. Does this award cover the cost the entire program?
2. Have you applied and/or received additional funding that may support this activity?
4. Would your child still have access to this program without the Mandin Award 7. financial assistance? (note: this does not impact your chance of receiving this award)

TECHNOLOGY - If you are applying for technology, please expand in detail: *If you are not applying for technology, you may leave this question blank

ADDITIONAL COMMENTS

F. Endorsement

Please have a professional endorse your application and provide the required application information to submit with your application.

*Note: The professional is someone who has knowledge of your child’s learning disability or challenges. This person may be a teacher, educational assistant, tutor, psychologist, or other (non-family related) individual who works with your child in a professional capacity. 

G. Declaration, Exclusion of Liability & Assumption of Risk

We hereby release and forever discharge, and do agree to indemnify and save harmless, the Learning Disabilities Association of Alberta and their employees, volunteers, or board members from all claims, demands, damages, actions, or causes of actions arising from or relating to participation in any aspect of the Mandin Family Award, and from any claims or demands whatsoever in law or equity, or heirs, executors or administrators may have in relation to the Learning Disabilities Association of Alberta.

I, the undersigned, hereby consent to the use, reproduction and publication of the Mandin Family Award application information, all forms of imagery, audio and related social media, of the recipient of the the Mandin Family Award, captured on behalf of the Learning Disabilities Association of Alberta as such may be deemed desirable in the interests of the general public for an unlimited period of time on a non-exclusive basis.

Collection of the information, all forms of imagery, audio and related social media is authorized under the FOIP Act, Section 32 (c), and is required for the purpose of awarding the Mandin Award, administered by the Learning Disabilities Association of Alberta.

The award information, all forms of imagery, audio and related social media will be used for promoting and preserving the history of the Learning Disabilities Association of Alberta Mandin Family Award and are subject to the disclosure rules set forth in the Freedom of Information and Protection of Privacy Act.

The decision of the Mandin Family Award Selection Committee is final and binding.

I have been given an opportunity to ask any questions that I may have.  I have fully informed myself of the outcomes of this release form by reading it before I signed it.