Request a Wheelchair

Submit the form below to be considered for a wheelchair through the Alec Project.

Apply for our wheelchair program.

You shouldn’t have to fight the world and a bad chair at the same time.


If you’re an adult who needs a wheelchair that fits your body and your life, apply today.

To be considered for the Alec Project’s wheelchair program, you must meet the following criteria:  
  • Be a person living with a disability as defined by the World Health Organization (WHO), including mobility, visual, hearing, cognitive, or speech disabilities.  
  • Demonstrate the need for a new wheelchair due to mobility challenges or deteriorating health.  
  • Have a clear financial need for assistance with the purchase of a wheelchair.  
  • Be able to use the wheelchair independently or with the help of necessary assistive devices or caregivers.  
  • Provide medical documentation from a healthcare provider to support your mobility-related needs.  
  • The wheelchair must be used primarily for personal mobility; no coverage is provided for wheelchairs used for recreational purposes.  

Request a wheelchair

Name
Please provide a brief description of your mobility needs and how a new wheelchair will enhance your daily life.
Please provide a personal statement about your current lifestyle and how your disability impacts your ability to perform daily activities.
Please provide a summary of your financial situation, including any additional costs related to ongoing medical expenses, disability-related needs, or assistive technology.
Please share how a new wheelchair will improve your independence, mobility, and quality of life. Explain why your current wheelchair (if applicable) no longer meets your needs, and how this new device will contribute to your personal goals.

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