Apraxia Voice is launching a new referral initiative that connects families to trusted professionals for a 12-Week Holistic Speech Support Program. We are currently accepting applications for this program, which is facilitated by independent providers Tori Starling, Holistic Health Practitioner and Coach, and Lena Livinsky, Holistic Speech-Language Pathologist & Feeding Specialist. This program explores the gut-brain-speech connection, possible root causes, and foundational whole-child support that may influence speech, behavior, and overall well-being. The program is intended to complement — not replace — traditional speech therapy or medical care. Participation is available as a scholarship provided by Apraxia Voice to the referring providers. Because space and individualized support are limited, families are asked to complete an application to ensure alignment, shared expectations, and meaningful participation for each child and family. The program begins the week of April 14, 2026 and the application deadline is March 22, 2026. Family InformationParent / Guardian Full Name(Required) First Last Email(Required) Phone(Required)Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Preferred Method of Contact(Required) Email Phone Call Text Message Your Apraxia Child DetailsChild Full Name(Required) First Middle Last Child Age(Required)Date of BirthMonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Gender(Required)School / Grade Level (if applicable)Speech Therapy & DiagnosisPlease provide as much information as possible to help tailor the program to your child’s needs.Has your child been diagnosed with Childhood Apraxia of Speech? If yes describe.(Required)Is your child currently receiving speech therapy? If yes, how long? If no or not now describe why.(Required)Is your child verbal? Explain, describe and provide emerging words.(Required)If your child uses spoken words, approx. how many words consistently?(Required)Has your child had any formal speech or developmental testing? If yes describe.(Required)If yes, do you have access to test scores or evaluation report?Health, Feeding, Development.Does your child have any comorbidities? If so describe.(Required)Would you describe your child as a picky eater? Please explain your challenges.(Required)Are there any health, or developmental concerns? Please describe.(Required)Consent and ParticipationCommitment and Readiness: This program focuses on education, lifestyle and whole child support. Are you willing to participate in all aspects?(Required)Are you willing to document observations related to your child's sleep, mood, eating, movement or communication during this program?(Required)Are you willing to follow through on recommendations consistently for the duration of the program?(Required)If selected, are you open to providing a written or video testimonial at the end of the program?(Required)Please read and acknowledge the following:(Required) I understand this program is educational and not a substitute for medical care I agree this program requires active parent participation I understand this is a limited scholarship opportunity, and not all applicants may be selected SignatureSignature(Required)Your typed name will act as your signature. DateMonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Optional QuestionsWhy are you interested in participating in this Holistic Speech Support Program?What changes are you most hoping to see for your child or family?What makes you feel ready for this type of program right now?
