Apply For Donation

Complete the donation application below for Share Your Blessings to consider gifting or subsidizing the cost of a Beamz Home edition interactive music system to you or your family. We review applications several times monthly and will let you know what we can for you in 4 to 6 weeks after submission.

To learn more about the Beamz Home Edition, click here to visit at the “At Home” section of the Beamz web site.

Apply For Donation - Beamz Home Edition

Form for U.S. residents to apply for a donation to receive the Beamz Home Edition interactive music product.

Name (requestor/guardian):*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Home Phone #:*
Mobile Phone #:
Email Address*
Enter Email Confirm Email
Name of Recipient:*
Requestor's Relationship to Recipient*
Does Recipient Have Access to Any of the Following:*
- iPhone 4S or later
- iPad 3 or later, iPad Air, iPad Air 2, iPad Pro
- PC (using Windows 7 or later)
- MAC (using OS 10.8x or later)
Recipient's Disability and/or Special Need:*
No. of Children In Recipients' Family (if applicable):
Annual Family Income:*
What benefit(s) do you feel the recipient/family will receive from the Beamz?*
Special Circumstances (please feel free to provide any additional information you would like to share for SYB to consider):
How Did You Hear About the Beamz? (if referred by an Organization, please advise of Organization Name, the Referring Individual and Phone#)*
Certification*
- I certify that the above is true and accurate. I also give Beamz Interactive and Share Your Blessings the right to contact us to get feedback from our experience using the Beamz product, and I authorize the use of any pictures, videos or testimonials I provide to be used on the Beamz and Share Your Blessings web sites, social media, promotional materials, and the like.
Application Submitted By:*
Date*
MM slash DD slash YYYY
I'm not a robot....