CO-FAB 2022 | Recipient Application
Form5 Prosthetics is on a mission to empower people to interact with their world and future more successfully!

CO-FAB x Form5 is a workshop that cultivates an environment to collaborate, ideate, and fabricate custom application devices designed by, and for, those with limb differences.

During CO-FAB, three recipients with limb differences work with a cohort of students and industry professionals. Each recipient will be assigned a team to collaborate and fabricate their own device. The Autumn CO-FAB cohort will meet on 9/24, 10/1, 10/8, and for the workshop weekend on October 14-16th.

Through CO-FAB, recipients have the opportunity to turn their ideas into prosthetics. Do you/your child/someone you know have a limb difference? Are you looking for a solution to a barrier you/your child currently face? If so, apply for CO-FAB! Please introduce yourself in a short video (2-3 min) and share with us your idea for your prosthesis! If you have difficulty uploading videos, please email them to info@form5prostheticsinc.org.

Learn more about CO-FAB 2022 by visiting; form5prostheticsinc.org/co-fab-workshop. Have questions or looking for additional information? Email info@form5prostheticsinc.org.
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Are you a recipient or a parent/guardian of a recipient? *
Parent/Guardian Name: *
First & Last
Recipient's Name: *
First & Last
Recipient's Age: *
Contact Email: *
Contact Phone: *
Where are you from? *
Our organization is located in Central Ohio and our workshop will be held in our area. If you are not located here, would you be able to travel and/or stay in Central Ohio?
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How did you find out about this opportunity? *
Have you worn a prosthesis before? *
If you said yes to the previous answer, how many prosthetics have you worn?
Please submit a 2-3 min video about you and your idea to info@form5prostheticsinc.org!
CO-FAB empowers our recipients with the confidence, resources, and support to accomplish anything they can imagine! In one to two sentence please describe your idea for your prosthesis: *
What distinctive pattern, design, or feature would you want your prosthesis to have that makes it unique to you? *
Do you have any allergies or dietary restrictions?
Is there anything else we should know about you?
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