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Dear Grant Applicant:

Thank you for requesting a grant from CATAPULT. It is the mission of CATAPULT to facilitate a lifestyle of health and fitness to physically challenged individuals so they may meet their personal goals and compete at all levels of athletics. CATAPULT is here to prove that disabilities are no limit to an individual’s capabilities. The goal of CATAPULT’s grant program is to provide financial assistance to help make a difference in the pursuit of achieving your athletic successes. Please fill out the application and provide all requested documentation. Your application is due by June 1, 2018 via e-mail submission to admin@teamcatapult.org. All grant requests submitted after that date will be put on a waitlist and considered only if funds are available. Should you not receive funding, we encourage you to reapply during the next grant period. Please be aware, if you are the recipient of a CATAPULT grant: you must return a signed letter of acceptance of CATAPULT’s grant terms and conditions; you must use your grant for the purpose described in this application; and you must submit receipts to prove the grant money was used for the purpose described in this application. If you have any questions about this application or CATAPULT’s grant process, please contact us at admin@teamcatapult.org.

Sincerely,

Jarrett C. Hubert and Christopher M. McClendon

Co-Founders of CATAPULT


APPLICANT INFORMATION
Name *
Name
Date of Birth *
Date of Birth
Phone Number *
Phone Number
Gender
Ethnicity
Have you ever received a CATAPULT grant before? *
Year, amount received, and what you utilized the grant for.
MILITARY
Did you serve in the United States Military and if so, which branch?
Did your parents serve in the United States Military? If so, what branch?
LAW ENFORCEMENT
Are you a former/current public safety employee?
If yes, what category of public safety did/do you serve?
Were you injured on the job?
CATAPULT INFORMATION
Please specify below.
Have you participated in any CATAPULT activities or programs? *
INFORMATION TO BE INCLUDED IN YOUR APPLICATION
If so, please provide name, date, and location of the event.
If so, please provide name, date, and location of the event.
if so, please describe the sport or physical activity and the training sought below.
If so, please provide the details of the equipment sought and why the equipment is necessary to achieve your goals.
Do you understand and agree that if you receive a grant, you will be required to submit receipts proving the grant was used for its intended purpose?
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DISABILITY INFORMATION
Select your physical disability. *
Check all that apply.
e.g., Bilateral below knee amputee, T9-T12 paraplegic
How did you acquire your disability? *
YOUR SPORT INFORMATION
What is your primary sport? *
What kind of athlete do you consider yourself? *
Check one that applies.
Have you ever compete in the Olympics/Paralympics?
What sport, year, and location? What were your results?
SUPPLEMENTAL INFORMATION
If so, please list below.
If so, please list below.
Will partial funding allow you to afford your request?
STATEMENT OF DISCRETION AND CERTIFICATE OF ACCURACY
Any decision by CATAPULT shall be made in the sole and absolute discretion of CATAPULT. This includes, but is not limited to, whether or not to award a grant and the terms and conditions attached to any grant. By your submission of this grant application to CATAPULT, you agree to be bound by CATAPULT's decision regarding your application, you waive all rights to legal recourse against CATAPULT for it's decision. *
CATAPULT uses the biographies and photographs of its athletes and grant recipients to assist in fundraising efforts to help us achieve out goals. Please authorize CATAPULT to use your photographs and/or biography. *
Print your name below that you agree to the above statement.
Date *
Date
Date
Date