Chair Force 1 Foundation Application

Applicants will NOT be chosen on a first-come first-serve basis. Applications will be accepted contingent upon available funds and outstanding commitments made.

Criteria

The recipient must have the current need of a wheelchair, must be a primary caretaker or dependent of someone using a wheelchair.

Special attention to Neurological Disease (The primary community we serve is the ALS community)

Priority given to wheelchair accessible van needs over other medical equipment or financial needs.

Priority given to permanent wheelchair need over temporary need

Application

First Name

Last Name

Recipient Date of Birth required

How did you hear about Chair Force 1 Foundation?

Do you have any minor dependents?

If you have school age children please include school details (name, do you pay tuition and if so how much).

Are you involved as an active member in your community with other non-profits, Churches, other causes? If so please provide details.

What medical equipment has insurance provided?

Have you been the beneficiary of other charities? If so, what have they provided and what charities are involved?

Have you requested help from other non-profits? Please list.

What medical equipment have you purchased yourself?

What is your biggest need?

What medical equipment are you requesting from Chair Force 1 Foundation?

Additional Chair Force 1 Services

Wheelchair Accessible ramp installation

School tuition assistance for Minor Dependents

Thank you for your application.

A member of the Chair Force 1 team will be in touch soon.

Chair Force 1 Foundation Application

Criteria

Application

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