Breathe for Britt Movement Grant Application

Breathe for Britt Movement Grant Application

This grant supports individuals living with cystic fibrosis in accessing movement and wellness opportunities that strengthen the body, support lung health and improve quality of life. Grants of $250–$500 will be awarded
Section 1: Applicant Type
MyselfMy childSomeone I care for
Section 2: Basic Information
Applicants Full Name*
Email Address*
Phone Number*
Format: (000) 000-0000.
City / State*
Applicant's Age
Applicant's Date of Birth

MonthDayYear
Section 3: About You

Tell us a little about yourself or the person you're applying for. Share a few sentences about your interests, hobbies, or daily life.
About You
Section 4: Movement Activity
Gym membershipYoga or PilatesPersonal trainingSports programDance classSwimming lessonsHome fitness equipmentIf other please specify
If other, please specify:
Program or Facility Name (optional)
Estimated Cost
Funding Request
Section 5: Impact
How would this movement opportunity support your health or wellbeing?
What excites you most about this opportunity?
I give permission for my story to be shared publicly using first name and state only.I prefer my information remain private
Section 8: Eligibility
I confirm that I (or the individual I am applying for) have been diagnosed with cystic fibrosis and that the information provided in this application is accurate to the best of my knowledge.
Signature
Section 9: Privacy Statement
Information submitted in this application will only be used to review and award the Breathe Movement Grant
Email
example@example.com
Should be Empty:

Breathe for Britt Movement Grant Application

Section 1: Applicant Type

Section 2: Basic Information

Section 3: About You

Section 4: Movement Activity

Section 5: Impact

Section 8: Eligibility

Section 9: Privacy Statement