Adaptive Equipment Grant Application

Access Grant Application
Basic Contact Info:
Full Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail
Phone Number
Format: (000) 000-0000.
Diagnosis
Personal Statement
- Share your personal story, including your journey with your disability.
- Explain how sports and physical activity have impacted your life.
- Discuss challenges you’ve faced in pursuing your athletic goals.
- Share your long-term goals in sport and in life.
(Please provide 500-750 words).
Financial Statement

Our review team does consider socioeconomic status and applicants’ financial situation as a factor in grant eligibility. Please include either: last year’s tax return or a written statement about your financial situation
File Upload

Last years tax return (if applicable).
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Equipment Request
1. Are you requesting funding for (select all that apply):
What camp or clinic are you hoping to attend?
What program would you like to attend?
What event/competition are you hoping to compete in?
Equipment you are requesting:
Be as specific as possible, including make/model if known.
Why is this equipment needed?
How will this equipment help you achieve your goals?
Have you tried this equipment before? If yes, describe your experience:
Total cost of equipment:
We can't always fund 100% of costs but are willing to provide partial funding.
Please attach quotes, estimates, or invoices.

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Do you currently own any adaptive sports equipment? If so, what equipment and when did you obtain it? Did you receive any financial assistance in purchasing the equipment? If so, from who?
What is the cost of the camp, clinic, program, or competition?
2. Have you received any other grants in the past 3 years?
3. Are you applying for any other grants this Fall?
4. Do you represent any other organizations or brands?
5. Do you have any additional funding sources? If yes, please list:
Athletic Goals
Which sport/s do you compete in?
What do you hope to accomplish as an athlete?
Are you registered, or intend to register for any specific competitions in 2026?
How will this grant change your athletic journey or personal life?
If you are chosen as an AdaptX grant recipient, do you agree to include our logo on your competition gear or wear AdaptX apparel that we provide? (Logo on a singlet, sticker on a racing chair, etc.)
Please explain why not:
If you are chosen as an AdaptX grant recipient, are you willing to share your story?
Please explain why not:
Additional Information
Is there anything else that you would like our review committee to consider when reviewing your application?
Supporting Materials
Please submit a letter of recommendation from a coach, therapist, mentor, or community leader.

Required
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Please include a current photo of yourself participating in sport.

Optional
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Applicant Agreement

By signing below, I confirm that all information provided is true and accurate. I understand that grant funds must be used solely for the purchase of the adaptive equipment requested in this application.
Signature
Date

MonthDayYear
Date
Should be Empty:

Access Grant Application

Basic Contact Info:

Equipment Request

Athletic Goals

Additional Information

Supporting Materials