iMaB Scholarship Application

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Thanks for your interest in iMaB! Please take a moment to answer a couple questions, hit submit, and we will get back to you quickly! If you have questions or need to chat with someone immediately call 412-851-9642.

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Is the scholarship for you or someone else? *

Myself

Someone else

If you are nominating someone else, who are you to them? (If NA leave blank.)

What is the first and last name of the scholarship recipient? *

All further questions will be about the scholarship recipient: Age? *

Gender *

What level of physical support is needed to help this individual move? *

No support, can do all physical movements on their own.

Minimal support, may need help getting up and down or for balance.

A little support, might need help holding up limbs, standing etc.

A lot of support, has mobility but needs lots of help.

Maximum support, can not hold themselves up, needs limbs moved etc.

Sonstiges:

How do they communicate? *

Full sentences

Words or fragments

Sign language

Sounds or movements

Technology Support

Sonstiges:

Current level of movement? *

None

Some

A little

Frequent

A lot

Often

Sonstiges:

Is there a current diagnosis? If yes, please list. *

Any limitations or important information we should know about the health of mobility? *

Please name the groups, activities, organizations they currently participate in? *

What do they do currently when feelings stressed or anxious to feel better? *

How will the iMaB program benefit them? *

Why is financial support needed? *

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