Multisport Clinic Scholarship Application
Use this form to request a scholarship to attend our Multisport Clinic on March 7, 2026
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Date of Birth
What is your disability? (check all that apply)
*
Amputee/Limb Difference - Lower Limb(s)
Amputee/Limb Difference - Upper Limb(s)
Blind/Visually Impaired
Cerebral Palsy
Multiple Sclerosis
Muscular Distrophy
PTSD
Spina Bifida
Spinal Cord Injury
Stroke
Traumatic Brain Injury
Other
Have you served in the military?
*
Yes, active duty
Yes, veteran
No
The registration fee for this event is $25. How much, if any, can you afford to pay?
*
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 apply to 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? (can be anonymous)
*
Yes
No
% FPL
# circumstances
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