Application

To apply for this micro-grant, please fill out the form below and we’ll be in touch with you soon.

Name

First Name

Last Name

Phone

(###)

###

####

Athlete's name (If submitting for someone else)

First Name

Last Name

Athlete's age

Ambulatory

Non-Ambulatory

Ability

Physical Disability

Cognitive Disability

Emergency contact information

Tell us why you are applying for our adaptive sports micro-grant

Our tagline is “Do Good, Be Good.” How do you align with her vision?

Have questions?
Get in touch.