Empower SCI: Participant Application
Please complete the application and submit along with the non-refundable application fee. Applications will not be processed until the fee has been received.
Applications are accepted until the program is full.
Participants are accepted on a first-come, first-serve basis.
If accepted into the program, a physician referral form will be provided to you. Please ask your physician to complete the form and return it to Empower SCI by July 1.

**Fees and Program Costs**
Non-refundable Application Fee: $50
Program Cost: $2500
- A non-refundable deposit of $800 is due within two weeks of acceptance into the program. The remaining program cost will be collected upon arrival to the program in July.

Payment options:
- Checks may be paid to "Empower Spinal Cord Injury, Inc." and mailed to: Empower SCI, P.O. Box 8631, Boston, MA 02114
- PayPal Account: Empower Spinal Cord Injury, Inc.

**Application Timeline**
Applications open to the public on January 1
Final deadline for applications is May 1
Final decisions of participant list will be made by June 1
Final scholarship decisions will be made by June 1

**Scholarships are highly competitive at Empower SCI and we cannot promise financial assistance. If you are applying for a scholarship, we encourage you to pursue alternate funding opportunities while waiting for a scholarship decision.

**Program Dates**
July 16 to 29, 2017

Please note that if you are traveling by airplane to the program, we will provide transportation from Long Island-Macarthur Airport (ISP). If traveling to any other airport, transportation will need to be arranged by the participant for arrival at the Stony Brook University campus. If this is your first time traveling by airplane since your injury, we highly recommend that you are accompanied by a caregiver for the flight to/from the program. Please include this cost with any fundraising efforts.

Email address
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms