Injured Military Camp Scholarship Application
Use this form to request a scholarship and/or travel stipend to attend our Injured Military Camp on May 30-June 2, 2024
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
What is your disability? (check all that apply)
*
Amputation
Cerebral Palsy
Spina Bifida
Spinal Cord Injury
Stroke/TBI
Visual Impairment/Blind
Other
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The registration fee for this event and three nights' hotel is $25. How much, if any, can you afford to pay?
Travel stipends of up to $250 are available for this event. Do you need a travel stipend?
*
Yes
No
Approximately how much are you requesting? Maximum amount is $250.
How do you plan to travel to camp?
I plan to fly to Chicago and will need ground transportation to get to the camp
I plan to fly to Chicago and will get myself to the camp
I plan to drive to the camp
I plan to get dropped off at the camp
I plan to ride the Dare2tri bus from Chicago
Other
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Financial Information
Please describe your financial need and how a scholarship will help you to achieve your goals
*
Household size (# of people in household, including yourself)
*
Annual Household Income
*
Do any of the following describe you (check all that apply):
I am a full-time student
I am the parent of a child/children under 18
I am currently paying college tuition or repaying student loans
I am currently unemployed
I am eligible for SSI/SSDI
I receive SNAP, reduced school lunches, or other income-based assistance
Do you plan to participate in other Dare2tri programming this year (camps, practices, races, etc.)? If so, please list below.
*
Donations and grants are used to cover the cost of race scholarships. If requested, are you willing to write a thank-you note or provide a testimonial? (ok if anonymous)
*
Yes
No
% FPL
# circumstances
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