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2025 The Hartford Adaptive Equipment Grant Award
Nomination Form
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1.
Athlete First Name:
(Required.)
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2.
Athlete Last Name:
(Required.)
3.
Athlete E-mail (if known)
4.
Athlete Phone (if known)
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5.
Athlete Age
(Required.)
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6.
Athlete is a resident of the fifty (50) United States, including the District of Columbia and Puerto Rico who are at least thirteen (13) years old at the time of entry
(Required.)
Yes
No
Unsure
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7.
Athlete Sport(s)
(Required.)
Archery
Boccia
Cycling
Goalball
Para Powerlifting
Paratriathlon
Shooting/Air Rifle
Sitting Volleyball
Swimming
Table Tennis
Tennis
Track and Field
Wheelchair Basketball
Wheelchair Football
Other (please specify)
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8.
First Name of Nominator
(Required.)
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9.
Last Name of Nominator
(Required.)
*
10.
Nominator E-mail
(Required.)
*
11.
Nominator Phone
(Required.)
*
12.
Relationship of Nominator to Athlete
(Required.)
*
13.
How does the nominee lend support and encouragement to others to achieve their greatest potential?
(Required.)
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14.
How does the nominee serve as a role model within the adaptive sports community?
(Required.)
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15.
Provide multiple examples of how the nominee exhibits commitment, persistence, and/or discipline to their sport.
(Required.)
Current Progress,
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