The Travis Roy Legacy Grant Program

The Travis Roy Legacy Grant Program assists individuals with paraplegia or quad/tetraplegia due to a Spinal Cord Injury or Disorder (SCI/D) who demonstrate a financial need. These grants can help assist with obtaining either Durable Medical Equipment or Vehicle Modifications up to $5,000. These grants are awarded based on financial need and are reviewed by the SCIbostons’s Board of Directors. Grant disbursements are paid directly to the vendor. Upon our receipt of all documentation, please allow up to four weeks for your application to be processed.

Please carefully read the eligibility requirements below, as incomplete applications will not be considered. We are happy to answer questions regarding the grant or application process. Please contact us at: info@sciboston.org

Eligibility:

To be eligible, you must provide medical documentation of your spinal cord injury or disorder.
To be eligible, you must demonstrate a financial need. Total household income over $120,000 a year is not eligible. Personal fundraising (for example, gofundme) must be disclosed and may impact eligibility.
Paralysis must be due to an acquired Spinal Cord Injury or Disorder from an injury that is traumatic (sudden trauma damaging the spinal cord) or nontraumatic (damage to the spinal cord caused by infection, disease, or medical event). *MS and Spina Bifida are not eligible due to the availability of grant opportunities that specifically support these disorders. If you are unsure about your eligibility, please ask us.

Applicants must reside in Massachusetts, New Hampshire, Maine, Rhode Island, or Vermont.

Items Eligible for Grant:

• Durable Medical Equipment (DME) - Examples of eligible items include: upgrade and maintenance of wheelchairs, small home modifications including ramp and lift installation, computers, shower chairs/benches and other DME.

• Vehicle Modifications- Examples of eligible items include: hand controls, lifts, and wheelchair locking systems.

Application Requirements:

Individuals submitting the grant application are required to submit:

1) A completed application. All sections of the application must be completed; incomplete applications will not be considered.

2) Quotes and contact information from two potential vendors and/or contractors for the equipment or renovations requested in the application.

3) Two (2) reference letters – one needs to be a doctor’s note verifying your qualifying disability, the second letter from a clinician or non-family member describing the need for the requested item.

5) Proof of income (2 of the 4 choices)- please black out Social Security number - Examples of acceptable documentation include:

• Copy of your last two paychecks

• W2 wage and tax statement form

• SSI or SSDI statements

• Last tax return

Please Note:

If the item applied for exceeds $5,000, applicants must pay the balance or provide evidence they have secured the remaining amount before our grant is paid to the vendor.
Applicants must request specific durable medical equipment to apply for a grant; requests for "anything you can give" will not be considered. Rental equipment and vehicle purchases will not be considered.
For Durable Medical Equipment grants, only one item from a single vendor will be awarded. (Not multiple items.)
Grants are not available towards the purchase of a new or used vehicle. Funds are only available for modifications on a new or used vehicle.
This grant is not for recreational equipment. If you are looking for recreational or athletic adaptive equipment, you may wish to try the Kelly Brush Foundation or the Challenged Athletes Foundation
Grant applications are reviewed by the Board of Directors on a rolling basis and after submission can take up to four weeks to process.
Applicants may receive up to 3 grants, however, the applicant must wait one year to apply for an additional grant.
Grant money awarded is paid directly to the vendor. The grant does not reimburse for items or services already purchased or provided.

Application Procedure:

Complete application. Please do not leave any fields blank.
Email info@sciboston.org the following documents:
- Estimates and contact information from at least two (2) suppliers and/or contractors for the equipment or renovations requested in the application
- Two (2) reference letters – one needs to be a doctor’s note verifying your qualifying disability, the second letter from a clinician or non-family member describing the need of the requested item.
- Proof of income (2 of the 4 choices)- please black out Social Security number - Examples of acceptable documentation include:
  1. Copy of your last two paychecks
  2. W2 wage and tax statement form
  3. SSI or SSDI statements
  4. Last tax return
You will receive confirmation of the receipt of your application.
Allow up to 4 weeks for the Board of Directors to review and vote. You will be notified by email as to whether your grant has been awarded or declined.

Name

First Name

Last Name

Email Address

Address: Street, City, State, Zip/Postal Code:

Phone

(###)

###

####

Date of Birth

YYYY

Date of Injury

(estimate)

YYYY

Level of Injury

Cause of Injury

How did you hear about this grant?

Select Desired Grant Application

Please briefly tell us about yourself and why you are applying for the grant.

Please give a detailed description of the equipment or modification(s) for which you are applying, including manufacturer’s name, model numbers, etc. if applicable.

Please describe how the item or modification you are requesting will help benefit you in everyday life.

Other factors that you wish to be taken into consideration (health factors, living arrangements, financial or family issues etc.).

Is the applicant currently employed?

Employers Name and Phone Number:

Is the applicant currently a full-time student?

School Name and Graduation Date:

Total Household Income

Please select your total household income, before taxes. Total household income concludes income earned by a spouse, domestic partner, parent, step-parent, etc.

Are there other funding sources for the applicant? (i.e GoFundMe, Help Hope Live, etc.)

If yes, please list the approximate amount raised.

Total Monthly Household Expenses:

Please Include: -Rent/Mortgage -Utilities -Loans -Food/general Living -Childcare -Medical -Transportation (gas)

Have you submitted this item or modification for insurance coverage?

Please indicate whether or not you have submitted this item or modification for insurance coverage and describe why it was denied.

Vendor/Contractor Information

You must supply information for two different vendors/contractors with two separate quotes.

Vendor/Contractor #1 Company and Contact Name:

Vendor/Contractor #1 Address, City, State, Zip/Postal Code:

Vendor/Contractor #1 Phone Number:

(###)

###

####

Vendor/Contractor #1 Web Address:

Vendor/Contractor #1 Price Quote:

Vendor/Contractor #2 Company and Contact Name:

Vendor/Contractor #2 Address, City, State, Zip/Postal Code:

Vendor/Contractor #2 Phone Number:

(###)

###

####

Vendor/Contractor #2 Web Address:

Vendor/Contractor #2 Price Quote:

Vendor/Contractor Preference:

Please indicate if you have a preferred vendor or contractor.

Please indicate that you have sent the following attachments to info@sciboston.org:

Quotes and contact information from at least two (2) suppliers and/or contractors for the equipment or renovations requested in the application

Two (2) reference letters – one needs to be a doctor’s note verifying your qualifying disability, the second letter from a clinician or non-family member describing the need of the requested item.

Proof of income (2 of the 4 choices)- please black out Social Security number - Examples of acceptable documentation include: Copy of your last two paychecks, W2 wage and tax statement form, SSI or SSDI statements, Last tax return

Please click the email button below to attach required documents, or email required documents directly to: info@sciboston.org

The Travis Roy Legacy Grant Program

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