Adaptive Sports Scholarship Application | Sacramento Spinal Foundation

The spinal cord injury Adaptive Sports scholarship is designed to assist individuals with a spinal cord injury, whom are interested in adaptive sports or outdoor activities. Applicants must reside in Sacramento or Yolo County. Scholarship awards will not exceed $1000.00. Please complete the application completely and upload supporting documents.

Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email*
Day of Birth*
MM slash DD slash YYYY
Daytime Phone*
Alternative Phone Number
Gender
Date of Injury
MM slash DD slash YYYY
Level of Injury
Cause of Injury
Please describe how adaptive sports will enhance your daily life.
Please outline your source of income or financial support for the last 12 months.
Please provide detailed information about the equipment and/or modification you are requesting. Include 2 or more price quotes from vendors. Max. $1000
How will this equipment or modification impact your life?
Include other information you wish to be taken into consideration as we review your application.
Upload Price Quotes
Drop files here or
Max. file size: 10 MB, Max. files: 3.
Date
MM slash DD slash YYYY
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