We Periodically Giveaway a MagSHOCK® to Those People in Need

Grant Application

Since we are in wheelchairs ourselves, we understand the difficulties each of us may face while doing life on wheels. We also understand that times are hard for so many of us right now. Which is why we felt we needed to offer our Grant Program. This is our way to give when we can to those in need. We ask that you fill out the questionnaire below and let us know more about yourself. Each question tells us more about you and helps our staff immensely as we sort through all of the applications we receive.

  • If you have a Facebook page please provide the direct link to your page.
  • If you have a Linkedin page please provide the direct link to your page.
  • If you have a Instagram page please provide the direct link to your page.
  • FOLD & GO COMMUNICATION:

  • MEDICAL INFORMATION:

  • MM slash DD slash YYYY
  • MM slash DD slash YYYY
  • GRANT APPLICATION QUESTIONAIRE:

  • Please upload a copy of Last Year's Tax Return or a Social Security Benefits Letter/Statement. Please BLACK OUT your Social Security Number, and any Bank Routing information.
    Accepted file types: pdf, jpg, gif, png, Max. file size: 300 MB.