Hope Floats Confidential Application

Hope Floats Scholarships are available for:
- Learn-to-swim lessons (not swim team)
- 1 lesson per week for 3 months; frequency of lessons may vary by provider (you may reapply for continued support)
- The scholarship covers lessons cost only and not any additional fees that may be imposed by your swim provider
- Families are required to contribute financially toward lessons
- Any unused scholarship money will be returned to Hope Floats Foundation
- A completed survey is required prior to scholarship renewal.
*Please note that it can take up to 30 days for your application to be reviewed and processed, especially during our high volume months of June and July. We process applications in the order that they are received, and we will contact you as soon as yours has been reviewed. We appreciate your patience!*
Confidential Application for Tuition Support
Number of Scholarships approved - 0 for None

0123456
Notes
Date letter / or check sent

MonthDayYear
Date
Scholarship amount
Total Family Contribution
Survey Sent Date

MonthDayYear
Date
Survey recd? 1 or Yes - 0 for No

10
Income - AGI per Tax Return
Household Size- per Tax Return
Click to edit this text...
Section 1: Student Information
JotForm Generated

JotForm
How many children in your family are in need of Hope Floats Scholarships?
New Student Application or Returning Student

New StudentReturning Student
Student 1 - Name*

First NameLast Name
Student 1 - Date of Birth*

MonthDayYear
Date
Student 1 - Race:

WhiteBlack or African AmericanAmerican Indian or Alaska NativeAsianNative Hawaiian or Pacific IslanderOther
Student 1 - Other Race:
Student 1 - Hope Floats Scholarship Support*

ReturningNew
Student 1 - Swimming Ability (see definitions that hover for more information)

BeginnerIntermediateAdvanced
Returning Student 1 - A Survey has been completed at https://form.jotform.com/222372950132045

Yes
Student 2 - Name*

First NameLast Name
Student 2 - Date of Birth*

MonthDayYear
Date
Student 2 - Race:

WhiteBlack or African AmericanAmerican Indian or Alaska NativeAsianNative Hawaiian or Pacific IslanderOther
Student 2 - Other Race:
Student 2 - Hope Floats Scholarship Support*

ReturningNew
Returning Student 2 - A Survey has been completed at https://form.jotform.com/222372950132045

Yes
Student 2 - Swimming Ability:

BeginnerIntermediateAdvanced
Student 3 - Name*

First NameLast Name
Student 3 - Date of Birth*

MonthDayYear
Date
Student 3 - Race:

WhiteBlack or African AmericanAmerican Indian or Alaska NativeAsianNative Hawaiian or Pacific IslanderOther
Student 3 - Other Race:
Student 3 - Hope Floats Scholarship Support*

ReturningNew
Returning Student 3 - A Survey has been completed at https://form.jotform.com/222372950132045

Yes
Student 3 - Swimming Ability:

BeginnerIntermediateAdvanced
Student 4 - Name*

First NameLast Name
Student 4 - Date of Birth*

MonthDayYear
Date
Student 4 - Race:

WhiteBlack or African AmericanAmerican Indian or Alaska NativeAsianNative Hawaiian or Pacific IslanderOther
Student 4 - Other Race:
Student 4 - Hope Floats Scholarship Support*

ReturningNew
Returning Student 4 - A Survey has been completed at https://form.jotform.com/222372950132045

Yes
Student 4 - Swimming Ability:

BeginnerIntermediateAdvanced
Student 5 - Name*

First NameLast Name
Student 5 - Date of Birth*

MonthDayYear
Date
Student 5 - Race:

WhiteBlack or African AmericanAmerican Indian or Alaska NativeAsianNative Hawaiian or Pacific IslanderOther
Student 5 - Other Race:
Student 5 - Hope Floats Scholarship Support*

ReturningNew
Returning Student 5 - A Survey has been completed at https://form.jotform.com/222372950132045

Yes
Student 5 - Swimming Ability:

BeginnerIntermediateAdvanced
Student 6 - Name*

First NameLast Name
Student 6 - Date of Birth*

MonthDayYear
Date
Student 6 - Race:

WhiteBlack or African AmericanAmerican Indian or Alaska NativeAsianNative Hawaiian or Pacific IslanderOther
Student 6 - Other Race:
Student 6 - Hope Floats Scholarship Support*

ReturningNew
Returning Student 6 - A Survey has been completed at https://form.jotform.com/222372950132045

Yes
Student 6 - Swimming Ability:

BeginnerIntermediateAdvanced
Section 2: Parent/Legal Guardian Information
Parent Information*

First NameLast Name
Email Address*
example@example.com
Cell Phone*

Area CodePhone Number
Home Phone

Area CodePhone Number
Please enter your address with care and make sure to include your Apartment Number, if applicable.
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Country
Employer
Is a member of your immediate family active or retired military?

YesNo
Is a member of your immediate family a first responder (police officer, fire fighter, paramedics, etc.)?

YesNo
Section 3: Swim Lessons/Provider Information
Name of Swim School*
Can't find your school? Select Other above.
If you selected Other above, enter your desired swim school here:
If multiple locations which location will you be attending?
How much does your provider charge each month/session?*
Website of Swim Lessons Provider*
Has your child participated in a baby class at this swim school?

YesNo
Section 4: Financial Information
How much can you afford to pay per child for swim lessons each month? Hope Floats requires ALL families to financially contribute towards their lessons. If you are a Returning Hope Floats Scholar, you must maintain your current family contribution level, unless you have special circumstances and can share them in the "extraordinary situation" section below.*
Please check any of the boxes below that are relevant to your family's current situation.

My student has diagnosed Special NeedsSingle Parent HouseholdUninsured Medical ExpensesRecent Job LossOther (please write below)
If you have an extraordinary situation, including those indicated above, please explain how it impacts your family's capacity to meet full cost of swim lessons for your child(ren).
How did you hear about the Hope Floats Foundation?*
Please list any financial assistance received per year from the following sources
Do you receive aid to families with dependent children? If so, how much?
Do you receive Public Aid: Monthly/Food Stamps/WIC? If so, how much?
Do you receive alimony and /or child support? If so, how much?
Do you receive Social Security? If so, how much?
Other Income: retirement/disability/unemployment, etc? If so, how much?
Determining Financial Eligibility:

Documents We DO Accept:
- Previous year's page 1 of your tax return (1040 form)
  - Must include all children you are applying for as dependents
- Current SNAP benefits
  - Must include all children you are applying for as recipients
- Foster Care Paperwork
  - If you are applying for a foster child, we do not require you to submit a 1040 form or SNAP benefits. Simply submit the foster care paperwork for the child.
Documents We DO NOT Accept:
- Paystubs
- W2 form
- Social Security Documents
- Disability Documents
- Housing Documents
- Medicaid
Submitting the above documents will result in a longer than average application review period.
Upload the requested files here*

Browse Files

Cancelof
Hope Floats Foundation awards Tuition Assistance based on family financial need and availability of funds.
I understand that providing false or misleading information on any part of this application will disqualify me from any current or future tuition support from Hope Floats Foundation.*

Yes
I understand that tuition support may be withdrawn from any student who does not maintain a good record of cooperation and attendance.*

Yes
I understand that my application will not be reviewed and financial assistance cannot be granted if this application is incomplete (i.e. correct financial statements).*

Yes
Signature (use the mouse to sign)

Clear
Should be Empty:

Confidential Application for Tuition Support