The Hartford Adaptive Equipment Chapter Grantee Form

The Hartford Adaptive Sports Equipment Chapter Grant Activation Information Form

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The "Save & Continue Later" function can be found at the bottom of this report form. If selected, a pop-up notice will provide a unique URL which will allow you to access the form at a later time. The URL will also be sent via email to the primary email address listed. Move United cannot access partially completed forms or the URLs associated with the forms. To avoid information being lost due to connectivity or browser issues, a recommendation is to copy and paste this application to a word document, fill out the responses in the word document and then cut and paste answers to this application form for submission.
Member Organization Information
Member Organization Name*
Phone*
Email*
I have read and understand The Hartford's Adaptive Sports Activation Events Playbook*
https://moveunitedsport.org/app/uploads/2022/10/2022_2023-The-Hartfords-Playbook-for-Adaptive-Sports.pdf
- Yes
- Yes, but I have questions to discuss
- No
Three Proposed Dates for Activation Event
Please provide three proposed dates between February-September. Weekdays preferred (Tuesday, Wednesday, Thursday between 10am-2pm). If your program is receiving winter equipment, provide dates for an event Feb-March.
Option 1*
MM slash DD slash YYYY
Option 2
MM slash DD slash YYYY
Option 3
MM slash DD slash YYYY
Proposed Event Location*
Street Address Address Line 2 City State ZIP Code
Number of people attending the activation event
This will help with quantities for giveaways that will be shipped
How many people do you anticipate will attend the activation event?*
Confirm mailing address for event signage and giveaways, which will be shipped two weeks prior to event*
No PO Boxes

Street Address Address Line 2 City State ZIP Code
Attachments
Please attach the signed grant agreement, Invoice and your organization’s logo (eps/vector file in white) for event signage provided by The Hartford. If you do not have this file type, please upload highest resolution logo you have.
Signed Move United Grant Agreement*
Max. file size: 10 MB.
Grant Invoice*
Max. file size: 10 MB.
Submit
You should receive a confirmation notification to the email address submitted in your application. If you do NOT receive a confirmation, please contact Najeeb Siddiqui at nsiddiqui@moveunitedsport.org to confirm your submission was received for review.
Phone
This field is for validation purposes and should be left unchanged.

Save and Continue Later

The Hartford Adaptive Equipment Chapter Grantee Form

The Hartford Adaptive Sports Equipment Chapter Grant Activation Information Form

Save & Continue Later

Member Organization Information

Three Proposed Dates for Activation Event

Number of people attending the activation event

Attachments

Submit

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