AbleGamers 2013 Summer of Fun

AbleGamers 2013 Summer of Fun Grant Program

The AbleGamers Foundation is proud to offer a one time grant for gaming equipment.
Guardian / Caregiver

This grant is open to people of all ages, so please understand that we do not assume that all people with disabilities have a guardian. If you are your own caregiver, please fill this section out and select SAME AS ABOVE in the PERSON IN NEED section.
Name *

First Name Last Name
E-Mail *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone Number *

Area Code Phone Number
Person In Need - Information
Same as above?

Yes
Full Name

First Name Last Name
Birth Date *

Month Day Year
Sex *

Male Female
Nature of the Disability *
What are you looking for from the grant? *
General Household Information
Number of kids under 18 in the house?
Does the household already have a game system? (check all that apply)

Yes - XBox 360 Yes - Playstation 3 Yes - Wii Yes - PC No
Other Info you want to share with AbleGamers to help the selection process
Household Income

Under $25,000 $26,000 - $35,000 $36,000 - $45,000 $46,000 - $60,000 $60,000 - $80,000 More than $80,000
Should be Empty:

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AbleGamers 2013 Summer of Fun Grant Program