Life Could BE Better -

Thank you to the Enterprise Mobility Foundation for providing the grant to support this program. SBWIS will grant up to $50.00 total (includes prime free shipping or shipping cost of non-prime items) per SBWIS member for the purchase of adaptive items(s). The adaptive items(s) must be available for purchase on Amazon and you must provide a description of the exact item(s) in your request. Upon approval, SBWIS will purchase the item(s) from Amazon and have it shipped directly to your home. Recipients of a device through this fund should email a photo to SBWIS within one week of receiving the device. Your photos help us promote this program and give others ideas of what to choose. We are happy to provide you with this support in 2025!

Name of person with SB

First Name

Last Name

Date of birth

Name of person completing this form

First Name

Last Name

Email address of person completing this form

Home mailing address

This address will be used for shipping the item(s) purchased.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone number for Amazon to use if there are issues with the delivery

(###)

###

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Wisconsin County you reside in

Life Could Be Better if SBWIS purchased this item(s):

Provide a detailed description of the item(s) you wish for SBWIS to purchase. Description should include the Amazon link as well as the specific name of item, color you desire, size needed, & price on Amazon. Providing detailed information will speed up the process of placing the order.

Price of this item listed on Amazon

I understand that I must email a photo within one week of receiving the device.

Thank you for sending a photo to sbwis@sbwis.org.

Describe how the item(s) you are requesting are related to having spina bifida and how it will help you

For example, I'm requesting this cooling towel because I have a hard time regulating my body temperature in the heat. This is important information for us to share with Enterprise Mobility Foundation about how this program helped our members and made your life a little better. Thank you for your response.

Submit for Life Could Be Better

Life Could BE Better -