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 United States Association of Blind Athletes-Missouri Chapter,  Inc.




Athlete's Name_________________________________________________________

Date of Birth____________      Cell Phone ___________________________________



Parent contact info, if different from above:

                          Cell/home  phone____________________________________________


Sport : ______________________

Current or most recent team_______________________________________________

Current or most recent coach_______________________________________________

Coach's contact information:

                          Cell/Home phone____________________________________________

                           Home or school address ______________________________________

Name of Program Applying For:_____________________________________________

Location of Program______________________________________________________

Website of Program______________________________________________________

Proposed Dates of Training________________________________________________

Cost of Proposed Training_________________________________________________


Rules and Guidelines for applicants:


1. Application must be signed per instructions below.

2.  Forms should be filled out completely to be considered.  USABA-MO Board of Directors will determine candidate eligibility based on information provided on and accessed through the application.   

3.  Grant amounts will be based on the published costs of the desired community program, and/or participant responsible for 1/3 cost of program, per discretion of the Board of Directors.

4.  Applicants must be residents of Missouri.

5.  Grants will be provided only in sports competed in at the USABA National or International Paralympic Games.

6.  A grant-winning athlete's adherence to the training regimen and schedule of the approved program will be a major factor in determining that athlete's eligibility for future grants.

7.  Money approved will be paid to the program applied for, not to the applicant.

8.  In deciding whether to award grants, USABA-MO will show a preference for those individuals who show the ability or potential to compete at "elite levels" as identified by United States Paralympics or the United States Association for Blind Athletes.  Opinions of past and present coaches will be considered, as well as published standards by the above organizations.

9.  USABA-MO will notify the applicant of approval or disapproval of grant awards within 4 weeks of receiving  an application. 



 "I, the applicant (or, if under 18, his/her parent or legal guardian), give United States Association for Blind Athletes - Missouri Chapter, Inc. (USABA-MO) permission to contact any of the coaches or organizations listed above to determine eligibility of the applicant for grant assistance, and agree to the rules and guidelines stated above”.


Applicant:___________________________________________________________________ Date:______________________




Date: ______________________


Mail completed application to:

USABA-MO Chapter, Inc

6714 Scanlan Ave.

St. Louis, MO  63139


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