Grant Application

We want to hear about you! If you are under eighteen and physically challenged, please tell us about yourself. We would like to know about your life.

Our policy in fulfilling approved requests is to directly purchase all products and services, rather than make monetary gifts.

*We are currently able to grant appropriations for up to a maximum of $500, so please submit requests accordingly.

You may submit your written account through our website, or you can email us your story.

To submit your story through our website, please enter your information below:

Your Full Name
Your Email
Date of Birth
Street Address
City/State/Zip
Home Phone
Parent/Guardian's Name
Parent/Guardian's Address
Parent/Guardian's City/State/Zip
Parent/Guardian's Phone
How did you hear about Challenged America?
Describe your disability.
How did you acquire your disability?
Describe the circumstances that have led you to submit your story to Challenged America.
How can Challenged America help you?
What is the brand/make of the item requested?
Estimated cost of request:$

You can also email us your story at submissions@challengedamerica.com.

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