Adaptive Equipment Grant Application

Ambassador Application
Personal Information
Full Name

First NameLast Name
Pronouns
Please specify:
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.
Social Media Handles:
(Instagram, Facebook, TikTok, LinkedIn, etc.)
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).
Motivation & Fit
What are your athletic goals for 2026/2027?
How can AdaptX help you achieve them?
Please specify:
Why do you want to be an Ambassador for AdaptX?
How do you currently promote inclusion in fitness and athletics within your community?
What unique perspective, skills, or experiences would you bring to the program?
Do you currently represent any other organizations or brands?
Do you have any additional funding sources?
Engagement & Marketing
How comfortable are you with sharing our mission and events on social media?
Do you have experience creating content? If so, are you willing to create any of the following forms of material for AdaptX?
Please specify:
To help us expand the reach and impact of our work, are you interested and confident in any of the following:
Commitment

Our Ambassadors commit to:
- Promoting our mission on social media and within their networks
- Competing under the AdaptX brand and representing the mission
- Participating in occasional meetings and campaigns
Do you agree to this commitment?
Please upload a recent headshot or photo of yourself competing.

Optional
Cancelof
How did you hear about the Ambassador Program?
Applicant Agreement

By signing below, I confirm that all information provided is true and accurate.
Signature
Date

MonthDayYear
Date
Should be Empty:

Ambassador Application

Personal Information

Motivation & Fit

Engagement & Marketing