Program Grant

WHEEL SERVE NC

Program Grant
This is a reimbursement grant for Wheel Serve NC programs. Receipts required.

WSNC programs are eligible for an annual $450 in reimbursement

*Wheelchair players are not eligible to apply.*
Date

MonthDayYear
Date
Program Location
Contact Person

First NameLast Name
Email
example@example.com
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Total Amount
$450 maximum
Would you consider receiving payment through PayPal? If not, a check will be issued to you.

YesNo
PayPal Account Name
For example: email address or @name
Check Payable To
Provide itemized list of expenses (max $450).
Funds provided through reimbursement until 12/31/25
Receipt Upload

Please provide receipt(s) to substantiate reimbursement.
Cancelof
2026 Program Grant Cycle: 1/1/26 - 12/31/26
Should be Empty:

WHEEL SERVE NC