Wrench-It-Forward: Repair-A-Bike INDIVIDUAL Scholarship Application
All responses to this form are confidential and will not be shared with any other organization, agency, or individual for any reason.
Email address *
What is your name? *
Your answer
What is your address? *
Your answer
What is your phone number? *
Your answer
Please describe your race and/or ethnicity in your own words:
Your answer
Which Repair-A-Bike course would you like to take? *
Which "Your Right to the Road" Smart Cycling Course would you like to take? *
Will you be able to attend all 6 sessions of the course? *
If you are unable to attend one of the above listed courses, we may be able to work with your schedule. What days and times are you normally available?
It is not a guarantee that we will be able to accommodate your schedule, but we will if enough other applicants make the same request. If at all possible please select available dates listed on prior question.
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Morning
Afternoon
Evening
What is the main reason you are interested in participating in Repair-A-Bike? *
Your answer
Would you want to take the course in English or Spanish? *
What is your primary mode of transportation? Walking, bike, RIPTA, Uber/Lyft, driving, other? *
Your answer
Are you currently employed? *
Your answer
Do you currently live at home with family? *
Your answer
How many individuals are in your household? *
Are you the head of household? *
Does someone else claim you as a dependent? *
What is your estimated yearly income? *
Are you a permanent resident of Rhode Island? *
Are you currently attending college classes? *
Are you a recent American immigrant? *
Are you currently enrolled in a re-entry assistance program (transitioning from incarceration)? *
Are you currently homeless? *
Is there anything else you'd like to tell us about why you'd be a good candidate for a scholarship? *
Your answer
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