Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Contact Name *Who should we communicate with about this requestOrganization Name (if applicable)Email Address *Primary contact for this application.Phone Number *Organization Type *--- Select Choice ---Nonprofit organizationVeterans organizationRehabilitation or medical facilityAssisted living / memory careSchool or education programCommunity or recreation programOtherWho Will Benefit From the SwingTell us about the people your organization serves and how a wheelchair swing would benefit them.Installation Location *City and State where the swing would be installed.Timeline for the Project--- Select Choice ---As soon as possibleWithin 3-6 monthsWithin the next yearStill exploring options Will applicable) the Funding StatusFunding already securedWorking with donors or sponsorsApplying for grantsStill exploring fundingOptionalApply for Community Giveback Sponsorship Skip back to main navigation
