Wrench-It-Forward: Repair-A-Bike GROUP Scholarship Application
All responses to this form are confidential and will not be shared with any other organization, agency, or individual for any reason.
What is your name?
What is your job title/position?
What agency or organization do you work for?
Address of organization:
What is your phone number?
How many individuals are in your group?
(Groups of individuals 5 or more may need to coordinate with course instructors to determine an alternate course schedule, if you have a group of more than 8 individuals please contact us directly:
Which bests describes the clients/members of your group? Check all that apply
Recent Immigrants to the U.S.
Transitioning from Incarceration
Living in Neighborhoods underserved by public transportation
Would you like to sign your group up for one of the below courses?
October Repair-A-Bike (Dates: 10/07, 10/10, 10/17, 10/21, 10/24)
November Repair-A-Bike (Dates 11/04, 11/07, 11/14, 11/18, 11/21
December Repair-A-Bike (Dates: 12/02, 12/05, 12/09, 12/12, 12/16, 12/19)
No, I would like to schedule a course specfically for my group
Which "Your Right to the Road" Smart Cycling Course would you like to sign-your group up for?
Sunday 10/27 10AM - 1PM
Sunday 11/24 10AM - 1PM
Sunday 12/15 10AM - 1PM
No, I would like to schedule a course specifically for my group
If your group is unable to attend one of the above listed courses, we may be able to work with your schedule. What days and times is your group normally available?
It is not a guarantee that we will be able to accommodate your groups schedule, but we will try. If at all possible please select available dates listed on prior question.
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