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.

Number of Scholarships approved - 0 for None

0 1 2 3 4 5 6

Notes

Date letter / or check sent

Date

Scholarship amount

Total Family Contribution

Survey Sent Date

Date

Survey recd? 1 or Yes - 0 for No

1 0

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 Student Returning Student

Student 1 - Name *

First Name Last Name

Student 1 - Date of Birth *

Date

Student 1 - Race:

White Black or African American American Indian or Alaska Native Asian Native Hawaiian or Pacific Islander Other

Student 1 - Other Race:

Student 1 - Hope Floats Scholarship Support *

Returning New

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

Beginner Intermediate Advanced

Returning Student 1 - A Survey has been completed at https://app.icontact.com/icp/sub/survey/start?sid=3617&cid=192897 IMPORTANT - Submit the survey using a "fake email address" with your child's name and date. Example: childsnamedate@gmail.com

Yes

Student 2 - Name *

First Name Last Name

Student 2 - Date of Birth *

Date

Student 2 - Race:

White Black or African American American Indian or Alaska Native Asian Native Hawaiian or Pacific Islander Other

Student 2 - Other Race:

Student 2 - Hope Floats Scholarship Support *

Returning New

Returning Student 2 - A Survey has been completed at https://app.icontact.com/icp/sub/survey/start?sid=3617&cid=192897 IMPORTANT - Submit the survey using a "fake email address" with your child's name and date. Example: childsnamedate@gmail.com

Yes

Student 2 - Swimming Ability:

Beginner Intermediate Advanced

Student 3 - Name *

First Name Last Name

Student 3 - Date of Birth *

Date

Student 3 - Race:

White Black or African American American Indian or Alaska Native Asian Native Hawaiian or Pacific Islander Other

Student 3 - Other Race:

Student 3 - Hope Floats Scholarship Support *

Returning New

Returning Student 3 - A Survey has been completed at https://app.icontact.com/icp/sub/survey/start?sid=3617&cid=192897 IMPORTANT - Submit the survey using a "fake email address" with your child's name and date. Example: childsnamedate@gmail.com

Yes

Student 3 - Swimming Ability:

Beginner Intermediate Advanced

Student 4 - Name *

First Name Last Name

Student 4 - Date of Birth *

Date

Student 4 - Race:

White Black or African American American Indian or Alaska Native Asian Native Hawaiian or Pacific Islander Other

Student 4 - Other Race:

Student 4 - Hope Floats Scholarship Support *

Returning New

Returning Student 4 - A Survey has been completed at https://app.icontact.com/icp/sub/survey/start?sid=3617&cid=192897 IMPORTANT - Submit the survey using a "fake email address" with your child's name and date. Example: childsnamedate@gmail.com

Yes

Student 4 - Swimming Ability:

Beginner Intermediate Advanced

Student 5 - Name *

First Name Last Name

Student 5 - Date of Birth *

Date

Student 5 - Race:

White Black or African American American Indian or Alaska Native Asian Native Hawaiian or Pacific Islander Other

Student 5 - Other Race:

Student 5 - Hope Floats Scholarship Support *

Returning New

Returning Student 5 - A Survey has been completed at https://app.icontact.com/icp/sub/survey/start?sid=3617&cid=192897 IMPORTANT - Submit the survey using a "fake email address" with your child's name and date. Example: childsnamedate@gmail.com

Yes

Student 5 - Swimming Ability:

Beginner Intermediate Advanced

Student 6 - Name *

First Name Last Name

Student 6 - Date of Birth *

Date

Student 6 - Race:

White Black or African American American Indian or Alaska Native Asian Native Hawaiian or Pacific Islander Other

Student 6 - Other Race:

Student 6 - Hope Floats Scholarship Support *

Returning New

Returning Student 6 - A Survey has been completed at https://app.icontact.com/icp/sub/survey/start?sid=3617&cid=192897 IMPORTANT - Submit the survey using a "fake email address" with your child's name and date. Example: childsnamedate@gmail.com

Yes

Student 6 - Swimming Ability:

Beginner Intermediate Advanced

Section 2: Parent/Legal Guardian Information

Parent Information *

First Name Last Name

Email Address *

example@example.com

Cell Phone *

Area Code Phone Number

Home Phone

Area Code Phone Number

Please enter your address with care and make sure to include your Apartment Number, if applicable. Errors in addresses will result in no scholarship being received.

Mailing Address (where scholarship checks will be mailed) *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Country

Employer

Is a member of your immediate family active or retired military?

Yes No

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

Yes No

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?

Yes No

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 Needs Single Parent Household Uninsured Medical Expenses Recent Job Loss Other (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?

Please upload a copy of last year's Federal Tax Return with Social Security numbers REDACTED. THIS IS REQUIRED FOR ALL APPLICANTS AND WILL HOLD UP YOUR APPLICATION IF NOT ATTACHED. We will not be able to process your application without this. *The Federal Tax Return must show the child(ren) that you are applying for listed as a dependent. **If you do not file an annual Federal Tax Return, please upload formal documentation from the IRS stating you do not need to file taxes. NOTE: If you are applying for a Foster Child, please upload legal documentation awarding you custody by the State. *

Browse Files

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

Please Doublecheck your Address above before Submitting. Make sure to include your Apartment Number, if applicable.
YOU WILL NOT RECEIVE A SCHOLARSHIP CHECK IF YOU PUT IN AN INVALID ADDRESS.

Confidential Application for Tuition Support