Application

Bucket List Program

WHO IS ELIGIBLE?

An individual with a physical disability of any age is eligible to be a bucket list recipient.  In your application please provide contact info and medical diagnosis from treating physician.

Must live in WNY or 3 hours of Buffalo, NY.

WHAT CAN YOU ASK FOR?

Can ask for anything. Shatter your limits. Could be a trip (vacation), to meet someone (favorite athlete, artist, public figure), be someone for a day (mayor, police officer, baker), go somewhere you have never been (Bills game, London, NYC).

Can also ask for adaptive equipment you may need or want (adaptive bike, ramp, lift, etc.)

Each individual can have up to 10 items on their bucket list. Goal is to fulfill a few items in a two year span.

WHO CAN SUBMIT AN APPLICATION? 

Individual (self)

Parent/Guardian

3rd Party can submit, but please have the individual/family reach out to us so it is okay with them

WHERE SEND APPLICATION?

Please e-mail application to milesformattybuffalony@gmail.com

Download Application