Jonathin Perez Adaptive Sports Grant Application Applicant's Name * First Name Last Name Birthdate Month/Date/Year Guardian's Name * First Name Last Name Address Phone (###) ### #### Email * What is the applicant's amputation/ congenital limb deficiency? If multiple, please list all What is the primary sport or physical activity for which you are requesting this grant? * How long have you been participating in the sport you are requesting a grant for? * What is your experience in adaptive sports/athletics? * Do you belong to an Adaptive Sports Organization or other recreation program in your community? Yes No This grant will aid me in joining one How did you hear about us? ODS Website ODS Social Media JPAS Flyer Word of Mouth (friend, family, or acquaintance) Other Additional Information, Questions and/or Comments Thank you for your submission!
