CO-FAB 2019 | Recipient Application
As a growing, innovative non-profit organization, Form5 Prosthetics is on a mission to reinvent prosthetics and the world's perspective on disabilities!

CO-FAB by Form5 Prosthetics is a workshop that will support and cultivate an environment to connect, create, and fabricate assistive devices designed by, and for, those with limb-loss. This revolutionary workshop will allow recipients to be completely interactive in the creation of their own 3-D printed prosthesis.

During this four day workshop (November 8th-11th, 2019), the five chosen individuals with limb-loss and a selective group of college interns, will work together with the power of 3-D printing to connect, create, and fabricate life-changing prosthetic devices.
Learn more about CO-FAB by visiting, www.form5prostheticsinc.org

Through our CO-FAB workshop recipients have the opportunity to turn their ideas into prosthetics!
Are you someone with upper limb-loss who has a profession, passion, or hobby that you need a task-specific prosthesis for? If you have an idea for your prosthesis, we'll help you fabricate it!
Please introduce yourself in a short video (2-3 min) and share with us your idea for your prosthesis! Upload below.

Have questions? Email info [at] form5prostheticsinc [dot] org.

Are you a recipient or a parent/guardian of a recipient? *
Recipient's Name: *
First, Last.
Your answer
Recipient's Age: *
Your answer
Contact Email: *
Your answer
Contact Phone: *
Your answer
Where at in Ohio are you located? *
Your answer
How did you find out about this opportunity? *
Have you worn a prosthesis before? *
If you said yes to the previous answer, how many prosthetics have you worn?
Your answer
Please submit a 2-3 min video about your idea to info@form5prostheticsinc.org!
Our CO-FAB workshop will provide the resources & engineering personnel to turn your idea into a prosthesis! In one to two sentence please describe your idea for your prosthesis. *
Your answer
If chosen as a recipient for our 2019 CO-FAB workshop what would be your ultimate goal? *
Your answer
Is there anything else we should know about you? *
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of Aaron Westbrook. Report Abuse - Terms of Service