BoL Scholarship

Because of Logan Scholarship Application Form
PLEASE COMPLETE ALL THE QUESTIONS IN ORDER TO APPLY FOR THE SWIMMING SCHOLARSHIP PROGRAM.

You will need the following:

• Driver’s License
• Two current pay stubs (an additional two from your spouse/partner if applicable)
• Your most recent tax return (e.g. complete 1040 form, federal tax return, not your W2 form).

IF APPLICABLE PLEASE INCLUDE:
• A “Did Not File” taxes form - PROOF REQUIRED
• Social Security benefits statement Disability benefit statement
• Unemployment benefit statement
• Child Support statement

Because of Logan exists to honor the life of Logan, through swim safety awareness, education, training and to support families who have endured a loss through childhood drowning. In order to fulfil our mission, we encourage Infant Swim Resource (ISR) Self-Rescue® technique swim lessons. It is our mission to help families who can’t afford these lessons by granting scholarships for those who qualify.

Scholarships are reserved for families who truly cannot afford lessons. Qualifying families will be responsible for the registration fee due upon enrollment. This fee will be reimbursed to the family upon successful completion of the program. Each family will be asked to commit to a financial contribution toward the lessons. This amount will depend on your individual financial situation.

ISR lessons begin with a 6-week program requiring a 10-minute time commitment daily (Monday – Friday) for the entire duration of the 6 weeks. We ask that before you fill out the application below you are ready and able to dedicate the time to classes. Failure to attend classes will result in the loss of your scholarship.

Your application must be complete, including all required documentation, in order for us to review your request.

We ask that if you have not spoken with your local ISR instructor that you first visit the website www.infantswim.com and find the closest instructor that can accommodate your schedule.

We will carefully review every application and has the right to ask more questions or not accept the application if we feel the submitted information is incomplete or contains some inaccuracies.

Name *

First Name Last Name
Have you ever received a scholarship from Because of Logan?
If yes, please explain.
Please describe in DETAIL why you need the scholarship.
Have you applied for a scholarship with another non-profit?

Parent / Legal Guardian Information
Parent / Legal Guardian Full Name

First Name Last Name
Parent / Legal Guardian Date of Birth

Month Day Year
Date
Parent / Legal Guardian Phone Number
Please enter a valid phone number.
Parent / Legal Guardian Email
example@example.com
Do you own or rent your home? *
Parent / Legal Guardian Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Parent / Partner / Legal Guardian 2 Full Name

First Name Last Name
Parent / Partner / Legal Guardian Date of Birth

Month Day Year
Date
Parent / Partner / Legal Guardian 2 Phone Number
Please enter a valid phone number.
Parent / Partner / Legal Guardian 2 Email
example@example.com
Parent / Partner / Legal Guardian 2 Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Employment History

We will carefully review every application and reserve the right to ask more questions or not accept the application if we feel the submitted information is incomplete or contains some inaccuracies.
Parent / Legal Guardian 1 Employer *
Parent / Legal Guardian 1 Occupation / Title *
Parent / Legal Guardian 1 Supervisor Name *

First Name Last Name
Supervisor Phone Number *
Please enter a valid phone number.
Parent / Legal Guardian 1 Length of Employment *
Parent / Legal Guardian 1 Weekly Hours Worked *
Parent / Partner / Legal Guardian 2 Employer
Parent / Partner / Legal Guardian 2 Occupation / Title
Parent / Partner / Legal Guardian 2 Supervisor Name

First Name Last Name
Supervisor Phone Number
Please enter a valid phone number.
Parent / Partner / Legal Guardian 2 Length of Employment
Parent / Partner / Legal Guardian 2 Weekly Hours Worked
Combined Gross Monthly Income (before taxes) *
Other income (child support, public assistance, etc) *
Did you file taxes last year?
If no, please explain:
Weekly amount you CAN afford if you have multiple children please list how much you can afford PER CHILD *
Any additional information you would like for us to consider regarding your financial situation?

Dependents

Please share more information about your family. Please be sure to list all children / dependents in your family, even if you are not applying for a scholarship for all.
Child 1 Name

First Name Last Name
Child 1 Date of Birth

Month Day Year
Date

Additional Children
Child 2 Name

First Name Last Name
Child 2 Date of Birth

Month Day Year
Date
Child 3 Name

First Name Last Name
Child 3 Date of Birth

Month Day Year
Date
Child 4 Name

First Name Last Name
Child 4 Date of Birth

Month Day Year
Date
Child 5 Name

First Name Last Name
Child 5 Date of Birth

Month Day Year
Date

History
Have you had a drowning in the family? Has your child experienced a drowning, either fatal or non-fatal (that required at least one night stay in the hospital)?
If yes, please include details of the event like name of child, date of event, age of child, circumstances of the drowning.

Lesson Request

Please list each child you are requesting lessons for.
Child 1 to Receive Lessons

First Name Last Name
Child 1 Lessons: New or Refresher Course?
Child 1 Gender
Lesson time preferences

Early morning Afternoon Evenings No preference
Permission for child's name to be in photos?
Have you already spoken to a swim instructor? (if no please visit infantswim.com to ensure there is an ISR instructor in your area and their availability before applying)
If yes, please provide the instructors name. Please note the instructor MUST know that you are applying for a scholarship.
What is their weekly fee? *
Please provide their contact informaion. *

Additional Lesson Requests
Child 2 to Receive Lessons

First Name Last Name
Child 2 Lessons: New or Refresher Course?
Child 2 Gender
Child 3 to Receive Lessons

First Name Last Name
Child 3 Lessons: New or Refresher Course?
Child 3 Gender
Child 4 to Receive Lessons

First Name Last Name
Child 4 Lessons: New or Refresher Course?
Child 4 Gender
Child 5 to Receive Lessons

First Name Last Name
Child 5 Lessons: New or Refresher Course?
Child 5 lessons gender
Additional Information
Have you taken a vacation/trip in the past 4 months?

If yes, please explain:
Are you planning a vacation/trip in the next 4 months?
If yes, please explain:
Do you currently have annual passes to any theme parks?
If yes, please explain:

Contact
How did you hear about us?
Friend or referral's name

Attach Required Documents
Upload required documents below. All documents must be uploaded for your application to be considered. For security purposes please block our your social security number on

Required Documents:
- Drivers License
- Two current pay stubs for each guardian
- Most recent tax return (e.g. complete 1040 form, federal tax return, NOT your w2 form)
If applicable, please include the following:
- "did not file" fax form-PROOF REQUIRED
- Social security benefits statement disability benefit statement
- Unemployment benefit statement
- Child support statement
APPLICATIONS WILL NOT BE PROCESSED UNTIL ALL REQUIRED DOCUMENTS ARE SUBMITTED
Parent / Partner / Legal Guardian 1 Drivers License *

Cancel of
Parent / Partner / Legal Guardian 2 Drivers License

Cancel of
Parent / Partner / Legal Guardian 1 Pay Stub (1 of 2)

Cancel of
Parent / Partner / Legal Guardian 1 Pay Stub (2 of 2)

Cancel of
Parent / Partner / Legal Guardian 2 Pay Stub (1 of 2)

Cancel of
Parent / Partner / Legal Guardian 2 Pay Stub (2 of 2)

Cancel of
Tax Return (i.e. a complete 1040 form, federal tax return, NOT your w2 form)

Cancel of
Please include the following, if applicable:
If no Tax Return, please upload "did not file" fax form-PROOF REQUIRED

Cancel of
Social security benefits statement disability benefit statement

Cancel of
Unemployment Benefit Statement

Cancel of
Child Support Statement

Cancel of
Tax Return for Guardian 2 (if not married)

Cancel of

Signature acknowledging everything included in your application is true and accurate: *

Clear
Should be Empty:

Because of Logan Scholarship Application Form

Parent / Legal Guardian Information

Employment History

Dependents

History

Lesson Request

Additional Information

Contact

Attach Required Documents