Automobile Modification/Adapted Driving Instruction Financial Assistance Application
Requested Amount cannot exceed $500 for hand controls and/or driver's education
This form must be submitted with supporting documentation (invoice) prior to payment.
Invoices can be emailed to firstname.lastname@example.org or faxed to 513-914- 4931.
By submitting this form, I certify that all the information provided is true and correct. I certify that the items listed are for the benefit of the applicant. If any information is intentionally false, I agree to reimburse SBCC all costs, legal and otherwise to recover disbursed funds.
An acknowledgement will be sent to you when payment is made.
Name Address Line 1, Address Line 2 City, State Zip Code Cell Phone Contact Email
Thank you for submitting your Camp and Recreation Scholarship Application. Please allow 3 business days for processing. You will be notified when payment has been processed.