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Grant Appplication

GRANT OPPORTUNITIES

The Run To Breakthrough provides ongoing grant opportunities to continue our work and mission of providing necessary resources to improve the quality of life for individuals with disabilities and their families. If you have any questions while completing this form, please contact [email protected].

About You

Applicant Name(Required)

First Last

Applicant Date of Birth(Required)

MM slash DD slash YYYY

Guardian Name

First Last

If Applicable

Guardian Relationship to Applicant

Family Member

Friend

Other

If Applicable

Your Address(Required)

Street Address Address Line 2 City State ZIP Code

How Can We Reach You?

We would love to chat with you. How can we get in touch?

Your Email Address(Required)

Email Address Confirm Email Address

Your Phone(Required)

How did you hear about The Run To Breakthrough?(Required)

Friend

Family Member

Social Media

Other

Grant Application

Has the applicant ever received funding from The Run To Breakthrough?(Required)

Yes

Please explain. Provide year funding received(Required)

Current yearly household income (Please state amount)(Required)

Please share your story (include all relevant information leading to the current situation)(Required)

Please tell us more about you and your family (interests, what inspires you, goals, fun activities you love to do together)(Required)

How does the applicant’s disability impact your family?(Required)

If awarded this grant, what is your plan for using the funding?(Required)

What impact would that have on you/your family?(Required)

If unable to fund the entire project, what is your potential plan to make up for the additional funding?(Required)

Please provide an invoice/statement indicating the total cost of the above-checked item. Please also provide verification that this is not a covered project/service from your insurance company.(Required)

Upload Invoice/Statement/Verification(Required)

Drop files here or

Max. file size: 6 GB.

Please explain any other information you feel would be helpful or is important for the grant committee to know about you, your family, and/or your project/goals.(Required)

I understand that if selected, I am only to receive the awarded funds at the time by The Run To Breakthrough. Any additional funding, The Run To Breakthrough is not required and/or expected to compensate for the difference.(Required)

Yes

This field is for validation purposes and should be left unchanged.

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The Long Island Community

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[email protected]

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