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Household Information
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Head of Household Requesting Assistance
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First
Last
Address
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City
State
Zip Code
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Number of adults who reside in the home
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1
2
3
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Number of children living in the household
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1
2
3
4
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Email
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Phone Number
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Student Information
Name of student(s) you are requesting scholarship for
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Age of student(s) you are requesting scholarship for
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2-4
5-7
8-10
11-13
14-16
17-18
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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?
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Your Occupation (if applicable)
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Employer's Name (if applicable)
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Employer's Address (if applicable)
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City
State
Zip Code
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Total Household Monthly Income
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Unemployment
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Child Support/Alimony
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Food Stamps
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Other Income or Support
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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
Instructors
SWIM LESSON REGISTRATION
Class Level Descriptions
FINANCIAL AID
Donate to Swim Beyond the Boundaries Inc
Financial Assistance
>
Scholarship Application
FAQ
LIFEGUARDING/ BLS/ CPR CERTIFICATION CLASSES
Testimonials
Contact
swim lesson philosophy