Empowerment Grant Application
The Empowerment Fund provides resources and inspiration to those who suffer a life-altering injury. These include spinal cord injuries, traumatic brain injuries, amputation or other mobility-limiting injuries that occurred in an individual's lifetime. The resources and inspiration that High Fives provides comes in the form of Board-approved grant funding, paid to service providers in specific funding categories: living expenses, insurance, health, travel, adaptive equipment, winter equipment, and High Fives' healing network.
Email address *
Name *
First and last name
Your answer
Name of person filling out application (if different from above)
Your answer
Date of Birth *
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Address Line 1 *
Your answer
Address Line 2
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Phone number *
Please enter your number in the format ###-###-####
Your answer
Sex *
Date of Injury *
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T-Shirt Size *
How did you hear about High Fives and the Empowerment Grant Program? *
Your answer
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