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2024 UTF OPEN REGISTRATION
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Apply for a scholarship using the form below.
General Information
Name
(Required)
First
Last
Address
(Required)
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Email
(Required)
Personal Information
What makes you adaptive?
(Required)
Amputee
Spinal Cord Injury
Traumatic Brain Injury
Neurological
Congenital
Amputation Type
(Required)
Above/Below Knee
Above/Below Elbow
Unilateral
Bilateral
Spinal Cord Injury Type
(Required)
Select
Cervical
Thoracic
Lumbar
Neurological Type
(Required)
Select
MS
Epilepsy
Other
Date of Injury
(Required)
MM slash DD slash YYYY
Do you have a Criminal Record?
(Required)
Select
No
Yes
Do you use a wheelchair?
(Required)
Select
No
Yes
Have you applied before?
(Required)
Select
No
Yes
Health History
Medications, Injuries, Surgeries
Photo of yourself
(Required)
Accepted file types: png, jpeg, jpg, gif, Max. file size: 20 MB.
The Reason You're Here
Please answer and describe why to the following.
Where are you right now?
(Required)
Where do you project you'll be in 3-5 years?
(Required)
Where were you one year ago?
(Required)
Do you believe you are in control of your health and wellness?
(Required)
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