The Hartford Adaptive Equipment Chapter Grantee Form

The Hartford Adaptive Sports Equipment Chapter Grant Activation Information Form

"*" indicates required fields

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

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*

Option 2

Option 3

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.