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Application for Equipment Support

 

ALL REQUEST FOR SUPPORT MUST DIRECTLY BENEFIT SPORTING AND HEALTHY ACTIVITIES OR EVENTS FOR YOUTH AND ADULTS WITH PHYSICAL OR MENTAL DISABILITIES.

 

Elligibility Criteria for Support - Are you eligible?

 

Individual Program Descriptions (Read detailed guidelines)

 

Equipment Endowment Application

**Date funding is needed:

  Day:  Year:

**Name of Organization:



**Address:


**Phone#:


Fax#:

**Email Address:


**Contact Name:


**Title: 

**Number of people this will effect:

**Number of people your organization serves:


Other sources of funding


**Organization's Mission


 


**Type of request (please check all that apply.):

Sports/Fitness Equipment

Sports/Fitness Clothing

 

**Briefly describe the request (please include date of event, location, number of participants, etc. Please include sizes if requesting clothing.):


**Signature (Full Name) of Authorized Representative:


** MARKS ALL REQUIRED FIELDS