Grant Application

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Please answer the following questions so we can get to know you better!

Please Download and Read, The Following Documents BEFORE continuing on. If you have any questions, please contact Steve Wallace at steve@highfivesfoundation.com

Please verify that you have downloaded AND read all 4

Empowerment Application

- Yes, I have downloaded and read all 4 documents
- No, I have not downloaded and read all 4 documents
Did you suffer a life-altering injury while pursuing a dream in a mountain action sport?*
- Yes
- No
Did you suffer a spinal-cord injury?*
- Yes
- No
Did you suffer a Traumatic Brain Injury?*
- Yes
- No
Did you suffer a life-altering injury and now have goals in mountain action sports?*
- Yes
- No
Name*
First Middle Last
Age*
Date Of Birth*
Sex*
- Male
- Female
Birthplace*
Email*
Phone*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
T-shirt size
Date Of Injury
Give a description of the extent of your injury/injuries and how it/they occurred*
What is your recovery goal?*
How can High Fives help you reach your goal and follow through with your plan?*
Hospital*
Current Mountain
How did you hear about High Fives and our athlete scholarship program?
Have you applied for a High Fives athlete scholarship in the past?*
- Yes
- No
Adjusted Gross Income (reported on previous year's tax return)*
Briefly Explain your immediate needs*
Are you a paid professional in your sport?*
- Yes
- No
Do you have health insurance?*
- Yes
- No
How Many Days Were You In The ICU?*
How Many Days Were You In In-Patient Rehab? (if applicable)
Race (just for statistical purposes) (*)*
- Caucasian
- African American/Black
- Hispanic/Latino
- Asian
- Middle Eastern
- Pacific Islander
- Native American/Alaskan
Spinal Cord Injury Level (if applicable)
Complete/Incomplete Injury (if applicable)
Name of Person Filling out application*
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.*
- Yes

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10775 Pioneer Trail Truckee, CA 96161

info@highfivesfoundation.com

(530) 562-4270

About

High Fives Non-Profit Foundation, based in Truckee, CA, became an official 501c.3 non-profit on January 19, 2009. Founded by Roy Tuscany, the Tahoe-based organization supporting the dreams of mountain action sports athletes by raising injury prevention awareness while providing resources and inspiration to those who suffer life-altering injuries

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Grant Application

Please answer the following questions so we can get to know you better!

Please verify that you have downloaded AND read all 4

Empowerment Application

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