Spinal Network Grant Application
United Spinal Association and Hollister Inc., are proud to jointly operate the Spinal Network. Our goal is to support peer support groups that serve the SCI/D community with resources, training and increased public awareness.

This application is used to apply for a grant of no more than $500, which should be used to create, maintain or expand peer support for the SCI/D community. Preference will be given to those applicants who are actively seeking to assist people who have recently sustained a spinal cord injury or been diagnosed with a spinal cord related disorder.
  • Group Leader Information

  • Enter any professional credentials
  • List affiliations if any
  • - -
  • Group Leaders' experience with spinal cord injuries/disorders (200 words or less)
  • Group Information

  • How should the Group be listed on the Spinal Network website?
  • Does the group receive support, financially or otherwise, from any other organization? If so, please explain in 100 words or less (i.e. XYZ Hospital provides no-cost meeting space for group meetings. )
  • Enter geographic service area (i.e. Broward county, Florida or 50 mile radius around XYZ Hospital)
  • Group details

  • What do you plan to do with the requested funds? (200 words max.)
  • How will the requested funds be utilized?
  • Enter amount not to exceed $500.00
  • Approximately how many people will participate in this group?
  • Enter specific efforts that will be made to encourage the participation of people new to the SCI/D community? (100 words or less)
  • Upload letters of support if any. Multiple uploads are allowed in PDF, .doc, .docx, and .txt formats.
  • Terms & Conditions

    In order to qualify for a grant, applicants must agree to the following terms:
  • As a condition of receiving a grant, group leaders will be required to provide one opportunity for the sponsor to address your group.
  • / / :
    This is your preferred data for a sponsor visit.
  • / / :
    This is an alternative date to your "Preferred Date".
  • / / :
    This date will be used in the event that the first two are not feasible.
  • As a condition of receiving a grant, group leaders may be asked by sponsors to distribute samples and/or literature to group participants.
  • As a condition of receiving a grant, group leaders will be required to submit receipts and a brief summary of how grant funds were actually utilized.
  • Upon Receiving A Grant

    In order to process your funds, we will require the following:
  • This can be an organization or person.
  • Enter person name or organization name
  • Facility name or physical location, i.e., Suite 111, Building A, Room 216, etc.
  • Other

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