Organization Name * Select Field * Rehabilitation Recreation Neurological Research Phone (###) ### #### Email * Address Address 1 Address 2 City State/Province Zip/Postal Code Country 1) Please provide a brief overview of the organization. * 2) How does the organization intend to utilize the grant funding? * 3) What are the short-term, long-term & ultimate goals of the organization? * We will provide written or video testimony for AIAF * YES NO Thank you!
