Application

Apply to receive an all-terrain wheelchair in partnership with Extreme Motus.

Outdoor access should be possible for everyone. This scholarship program was created to help individuals with mobility challenges experience the outdoors in ways that may not have been possible before.

First Name

Last Name

Phone Number

City

State

Country

Are you applying for yourself or someone else?

Myself Someone Else

What mobility challenges does the applicant face?

Current mobility device(s) used

How often do you go outdoors currently?

What limits your ability to access outdoor environments today?

Why are you applying for this scholarship?

How would an all-terrain wheelchair change your life?

What activities or environments would you want to access?

Tell us your story

Have you explored other funding options?

Do you have someone who can assist/push the wheelchair?