Recipient Application Form

The Katz-Moses Woodworkers with Disabilities Fund is a 501(c)(3) organization, which among other services it provides, aims to connect woodworkers and makers to those in need in their local area. Recipients must be at least eighteen years of age with relevant documented proof of their disability. Recipients under the age of eighteen must have explicit parental consent. Please fill out this form to receive consideration as a recipient of items from our initiative. After we receive your application, we will contact via e-mail or by phone. All information on this form will be kept confidential and will help us find the best way to serve you. Please be advised that where there may be direct face to face contact between volunteers and recipients, we may require a criminal background check. If this is needed, we will contact you directly. This application is for consideration only and does not guarantee selection.

Legal First Name

Legal Middle Name

Legal Last Name

Gender

Birth Date

Address

City

State

Zip Code

E-mail

Phone Number

Languages Spoken

Please list any physical limitations:

{name}

How long have you been woodworking and making?

Do you utilize non-powered hand tools?

Select an option

How confident are you operating power tools safely (scale of 1-10)?

What kinds of projects do you enjoy undertaking?

Primary Difficulty in the Shop:

Secondary Difficulty:

Wish List (Devices or Tools):

{name}

Do you belong to any local unions or associations relevant to woodworking or making?

Are you interested in receiving an item built by a volunteer?

Anything else about you that you wish for us to consider [Character limit 750]:

{name}

Social Media Handles

Instagram, YouTube, Facebook, Tik Tok

{name}

How did you hear about the KMWDF?

Upload any relevant proof of disability

Attach file

Drop files here

Do not submit passwords through this form. Report malicious form

Alert