Kentucky-Indiana Chapter of Paralyzed Veterans of America (KIPVA)

Sports & Recreation Grant Application

Name *

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Street *

City *

State *

Zip Code *

Phone *

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Email *

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I am a: *

Note: Currently the KIPVA Sports Grant supports Lifetime PVA Members and Associate Members with a strong relationship to the chapter in participation and volunteerism.

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Lifetime Member

Associate Member

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Describe Request/Activity and How it Will Benefit You *

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I am requesting funding for *

Actual Costs

Estimated Costs

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Describe Costs *

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Total Estimated Request *

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All expenses will be reimbursed and will require receipts to be submitted for all items/events.

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I agree to the terms set in this policy *

Sports & Recreation Grant Application

Your Support Can Transform Lives.

Paralyzed Veterans of America