Athlete Recovery Fund

* required information

First Name:*
Last Name:*
Address Line 1:*
Address Line 2:
City:*
State:*
ZIP/Postal Code:*
Email:*
Phone:*
Cell Phone:
Birth Date:*	(mm/dd/yyyy)
Gender:*	Female Male
Marital Status:*
Adjusted Gross income *	(reported on taxes for last year)
Name of person filling out application:*
Relationship to applicant:*
Injury Level:*
Injury Date:*
Cause of Injury:*
Extent of Injury:*
Prognosis:*
Name of hospital (if applicable):
Hospital Address:
Room #:
Contact Person:
Name of Social Worker:
Name of Physician:
Briefly explain your immediate needs and concerns.:*
How did you hear about us?:*
Are you a paid professional in your sport?*	Yes No
Who is your sponsor or sponsors?:*


Waiver and Truth Statement
The statements and answers given in this grant application are true and correct. I understand that misstatements in this grant application could cause my application to be denied.
I Agree:*	Yes No
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Once the application has been completed and submitted the ARF board will review your request. Grants amounts and frequency will be provided based on how much has accumulated in the fund. The seriousness of the injury will also take priority along with financial need. For instance; if there are very little funds in the account ARF will be limited to the number of grants that it can provide. The board may decide to hold back on providing grants to lesser injuries so that there will be funds available in case a severe or catastrophic injury comes along.

Review process generally takes 30 days from submission. Typical waiting period to receive a grant is an additional 30 days after approval has been voted on.

All grants will be given on behalf of the athlete directly to the service or equipment provider only. No direct funds will be given to the athlete and ARF will not be able to reimburse athlete for expenses. This is why it is very important to complete the grant application as soon as possible.