Wrench-It-Forward: Repair-A-Bike INDIVIDUAL Scholarship Application
SUMMER 2020: THIS PROGRAM IS NOT CURRENTLY RUNNING DUE TO PANDEMIC. IF YOU SUBMIT AN APPLICATION YOU WILL NOT RECEIVE A RESPONSE.
* Required
Email address
*
Your email
Name (first and last):
*
Your answer
Street Address:
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Your answer
City:
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Your answer
Zip Code:
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Your answer
Phone number:
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Your answer
Date of Birth:
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MM
/
DD
/
YYYY
How tall are you? (For bike fitting)
Your answer
Please describe your race and/or ethnicity in your own words:
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Your answer
Which Repair-A-Bike course would you like to take?
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April Repair-A-Bike (Dates: 4/6, 4/9, 4/13, 4/16, 4/20, 4,23)
May Repair-A-Bike (Dates: 5/4, 5/7, 5/11, 5/14, 5/18, 5/21)
I would like to be informed of other course dates
Will you be able to attend all 6 sessions of the course?
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Yes
No
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
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?
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English
Spanish
What is your primary mode of transportation? Walking, bike, RIPTA, Uber/Lyft, driving, other?
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Your answer
Do you need a bike to get to work?
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Your answer
Are you currently employed?
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Your answer
How many individuals are in your household?
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1
2
3
4
5+
Do you claim anyone as a dependent?
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Yes
No
Does someone else claim you as a dependent?
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Yes
No
What is your household's estimated yearly income?
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below $20,000
between $20,000 - $30,000
between $30,000 - $40,000
between $40,000 - $50,000
between $60,000 - $70,000
between $70,000 - $80,000
above $80,000
Are you a permanent resident of Rhode Island?
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Yes
No
Are you currently attending college classes?
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Yes
No
Do you currently live at home with family?
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Your answer
Are you a recent American immigrant?
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Yes
No
Are you currently enrolled in a re-entry assistance program (transitioning from incarceration)?
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Yes
No
Are you currently homeless?
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Yes
No
We may not be able to offer full scholarships to all participants. How much (between $0 and $200) would you be able to pay if we can offer you a partial scholarship?
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$100-150
$75-100
$50-75
Under $50
I will not be able to take the class if it is not a full scholarship.
Is there anything else you'd like to tell us about why you'd be a good candidate for a scholarship? Also include any explanations for previous answers here.
*
Your answer
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