Working 2 Walk Travel Grant Application
Questions marked by * are required.
1. First Name *
2. Last Name *
3. Street Address *
4. City *
5. State *
6. Zip *
7. Country *
8. I am *
  • Paralyzed by spinal cord injury or other condition
  • Family Member
  • Other
9. Email: *
10. Confirm Email *
11. Airfare Expense (enter none if not flying) *
12. If Driving, Estimated Mileage Expense (enter none if not driving) *
13. Lodging Expense *
14. Do you need a personal assistant in order to travel? *
  • Yes
  • No
15. Personal Assistant Travel Expenses (we do not cover fees associated with caregiving as part of the travel grant award)
16. Please indicate other sources of funding you are pursuing and/or have received to help with your expenses. *
17. Have you received a travel grant in past years to attend Working 2 Walk? *
  • Yes
  • No
18. If yes, how did you use your experience at Working 2 Walk to further your advocacy work?
19. Please tell us about your past accomplishments and future plans as an advocate for cure. *
20. Any Additional Comments:
21. Telephone Number (this will be used only in the event that we need to contact you regarding travel/lodging inquiries *