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Household Information
*
Indicates required field
Individual Requesting Assistance
*
First
Last
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Number of adults who reside in the home
*
1
2
3
More
Number of children living in the household
*
0
1
2
3
4
More
Email
*
Phone Number
*
Student Information
Name of student(s) you are requesting scholarship for
*
Age of student(s) you are requesting scholarship for
*
2-4
5-7
8-10
11-13
14-16
17-18
Adult
Choose One
*
Male
Female
I am requesting for more than one student
Employment & Income
If you are unemployed but your spouse/partner is not, please fill in the following information for your spouse/partner.
Are you currently employed?
*
Yes
No
Your Occupation (if applicable)
*
Employer's Name (if applicable)
*
Employer's Address (if applicable)
*
Line 1
Line 2
City
State
Zip Code
Country
Total Household Monthly Income
*
Unemployment
*
Child Support/Alimony
*
Food Stamps
*
Other Income or Support
*
Upload: recent pay stub OR copy of last year's federal tax return OR proof of participation in WIC, Head Start, Peachcare for Kids, or Medicaid
*
Max file size: 20MB
Current proof of participation in WIC, Head Start, Peachcare for Kids, or Medicaid OR a recent pay stub or a copy of last year’s Federal Tax Return
I affirm to the best of my knowledge that the above information is true and complete. I agree to provide assistance or income documentation as requested, thereby completing the application. I understand this financial assistance is short term and will be reviewed regularly.
Submit
About
Our Team
Testimonials
More
SWIM LESSONS
Registration
Class Level Descriptions
Policies
FINANCIAL AID
What to know
Scholarship Application
Donate
LIFEGUARDING / BLS / CPR
FAQ
Contact
