Barrier Reduction: Athlete Assistance Funding Request Form

Sportable receives funding through the Commonwealth Neurotrauma Initiative (CNI) Trust Fund, administered by the Virginia Department for Aging and Rehabilitative Services (DARS) to reduce barriers for individuals with traumatic spinal cord or brain injuries to engage in the adaptive sports, recreation, and wellness programs Sportable provides. Individuals who have spinal cord injuries (SCI) or traumatic brain injuries (TBI) may apply for financial assistance to reduce barriers to participation in our programs. At this time, only Sportable members who have SCI or TBI caused by a traumatic event are eligible to apply. Athletes receiving transportation assistance are limited to 16 rides to/from programs per year, with exceptions considered on a case-by-case basis to ensure support is distributed equitably among as many eligible athletes as possible. Questions? Email Caitlyn@sportable.org

Name(Required)
Address
Do you have a Spinal Cord Injury (SCI) caused by a traumatic event?(Required)
Do you have a history of brain injury or concussion caused by a traumatic event?(Required)
Type of Assistance Requested(Required)
Format in dollar amount. If unknown, type "unsure."
Please explain why you need financial assistance to participate in Sportable's programs. Please include information about sources of income, financial hardship and capacity, public assistance received, and anything else you think will be helpful.

Transportation Assistance - Additional Required Questions:

If you are requesting transportation assistance, please complete the 3 questions below. *Please note, athletes receiving transportation assistance are limited to 16 rides per year, with exceptions considered on a case-by-case basis to ensure support is distributed equitably among as many eligible athletes as possible.
Which would you prefer?

Consent(Required)

By signing below, I certify that all information is true and correct to the best of my knowledge.

Electronic Signature (Type your name)(Required)

This project and related materials are supported by CTR010039 from the Commonwealth Neurotrauma Initiative (CNI) Trust Fund administered by the Department for Aging and Rehabilitative Services. The contents are the sole responsibility of the authors and do not necessarily represent the official views of the CNI Trust Fund or DARS.