apply for equipment

apply for equipment


 If you are in need of adaptive sports or recreation equipment, or need a prosthetic limb that will allow you to play sports, please follow our application process. 

 


Complete and submit the form below to start the process. We will then email you the formal equipment application forms to be completed and signed. 

Please send us two photos of the applicant. Photos must be of the applicant only. 

Currently accepting applications from United States residents. 

Please allow up to four weeks for us to process and review your application. We will then contact you at the listed phone number or email that you have provided. 

Please understand that we are unable to assist everyone who applies, but we will do our best to help as many as possible. 
What is your medical disability?:
Will you be able to provide a signed medical verification letter from your health care provider (physician, physical therapist, occupational therapist or prosthetist) that confirms your medical disability?:
Will you be able to provide an equipment referral letter from your (physical therapist, occupational therapist, prosthetist, coach or trainer) that details your ability and potential to use this equipment?:
Are you or have you previously served in the U.S. Military? :
What is the adaptive sports equipment or sports prosthesis you are applying for?:
What is your prior experience in using the piece of equipment you are applying for?:
What is your plan for becoming proficient with this piece of equipment? Do you already engage in these activities through other organizations, or athletic / sports clubs?:
Do you have a physical therapist, occupational therapist, coach or trainer who will assist you in becoming proficient with this piece of equipment?:
Please detail your prior history and participation in sports, athletics and recreation? What physical activities, exercise, sports and recreation are you currently involved in?:
Do you have health insurance?:
Has your insurance provider refused coverage of the requested item?:
If you are chosen to be a GIVABILITY recipient, are you willing to provide follow up photos and videos of you using the adaptive sports equipment?:
If you are chosen to be a GIVABILITY recipient, are you willing to provide us with a "Thank you" video, thanking the GIVABILITY organization and the GIVABILITY donors?:
If I am gifted equipment from GIVABILITY and this equipment is no longer used by myself, I will contact GIVABILITY to return the item so that they may gift it to another individual in need?:
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