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 NameLast Name
E-Mail*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
Person In Need - Information
Same as above?

Yes
Full Name

First NameLast Name
Birth Date*

MonthDayYear
Sex*

MaleFemale
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 360Yes - Playstation 3Yes - WiiYes - PCNo
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 - $80,000More than $80,000
Should be Empty:

AbleGamers 2013 Summer of Fun Grant Program