Scooter Relief Fund Request_1

To request a grant from the Vespa Club of America Scooter Relief Fund please complete the following fields.

Required fields are marked with an asterisk.

First & Last Name *

Current Street Address *

City *

State*

Zip Code*

Email Address*

Telephone Number*

Loss Description

Please descrie the extent of your losses. You do not need to provide a detailed itemized list, rather, give us an idea of whether you are permanently displaced, have lost your home, all your possessions, or whether your losses are more limited.

Loss Details*

Please describe what the requested funds will be used for. (Replacement of clothing, repair of scooter, temporary housing, transportation, etc.)

Grant use details*

Grant Details

VCOA Scooter Relief will be making assistance grants on a rolling basis. In an effort to make sure we serve all those in need, the first round of grants will be for $0 (scooter parts/labor) to $500. Receiving a first round grant does not preclude an applicant from requesting additional assistance in the future.

Amount requested*

If you have asked for scooter parts or labor instead of a financial grant, please provide the following information as well:

Scooter make, model, and year

Scooter damage

Electrical
Paint
Body
Mechanical

Parts requested (Be specific, please)

File attachment - If you would like to share any files with us, photos etc. please do it here.

Select Files

References

Please provide two resources within the local or national scooter community as references

Reference 1 name*

Reference 1 email address*

Reference 2 name*

Reference 2 email address*

Additional details - Anything else that you would like us to know or you would like to share with us please enter here.

Submit