2024 Activity Scholarship Application
NOTE: In 2024, the annual amount an individual with Spina Bifida can receive from combined grant and scholarship funds cannot exceed $1,000. You MUST submit a new application for each monetary amount requested. In order to receive reimbursement, a paid receipt must be submitted. Otherwise, a bill must be submitted and payment will be made directly to the provider.

This form must be submitted prior to the start of camp or activity. You will be notified of your acceptance. Camp scholarships are limited and are offered on a first come, first served basis, annually.

BY SUBMITTING THE FORM I CERTIFY THAT ALL THE INFORMATION PROVIDED IS TRUE AND CORRECT. I CERTIFY THAT THE ITEMS LISTED ARE FOR THE BENEFIT OF THE APPLICANT. IF ANY INFORMATION IS INTENTIONALLY FALSE, I AGREE TO REIMBURSE SBSTL ALL COSTS LEGAL AND OTHERWISE, TO RECOVER THE DISBURSED FUNDS.

To encourage families to enroll children and adults with Spina Bifida in community-based recreational activities, Spina Bifida of Greater Saint Louis offers individuals living in our service area up to a $1,000 Activity Scholarship each calendar year. You MUST submit a new application for each monetary amount requested.

Some examples of camps or programs which are eligible for reimbursement:
Specialized camps for those with Disabilities
Adapted sports Programs or Lessons  
Recreational Programs    
Hippotherapy (horseback riding)  

All supporting documents (receipts, invoices, etc..) must be submitted to sbstl@charter.net.
The $1,000 is an annual limit per individual for all 3 Grants combined. (i.e. an individual in the same calendar year cannot receive a $1,000 Activity Scholarship and a $1,000 Educational Scholarship.)

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Email *
Today's Date: *
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Name of Individual with Spina Bifida: *
Birth Date: *
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Name of Parents or Guardian (if a minor): *
Street Address: *
City: *
State *
Zipcode: *
Phone Number: *
Name of Activity: *
Description of Activity: *
Address of Activity: *
Contact Name and Phone Number: *
Cost: *
List Date(s) of Activity: *
Make Check Payable To:
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