NCSCIA Individual COVID-19 Relief Grant
Mailing Address (Please include Apt. Number, if applicable)
Address Line 2
State / Province / Region
Postal / Zip Code
Injury Type and Level
Date of Birth
Please provide a brief description of the challenges you are experiencing due to COVID-19.
Please select all that apply to you.
Gift Card Choice
Walmart Gift Card
Target Gift Card
Are you members of NCSCIA? (www.ncscia.org)
Are you a member of United Spinal? (www.unitedspinal.org)
Were you a recipient of the United Spinal COVID Relief Grant of $500?
I would like to receive N95 face masks, limit 2 per applicant, while supplies last.
I would like receive hand sanitizer, limit 1 per applicant, while supplies last.