Swimming to Survive Scholarship Application Form

swimming to survive scholarship application
Read and follow the instructions carefully prior to submitting your application.

Eligibility Requirements:

1. Location: Applicants must reside in South Mississippi.
2. Transportation: Applicants must have reliable transportation to and from lessons.
3. Commitment: Scholarship recipients must commit to attending swim lessons every day. Vacations and absences must be pre-approved by the instructor.
4. Age & Ability: Swimmers must be between the ages of 6 months to 4 years and show a demonstrated interest in learning and improving their swimming skills.
5. Parental Involvement: Parents/guardians must agree to attend a minimum of 2 parent meetings or volunteer 2 hours in support of the swim program.

Scholarship Benefits:
-Full coverage of survival swim lesson fees, including pool time and coaching costs.
If selected, you will be asked for documentation to support the data you provide. Likewise, all correspondence and award agreements will be generated from the personal information submitted below. Please use proper spelling, capitalization and punctuation.
I. Student Data
Student Gender

MaleFemale
Full Name*

First NameLast Name
Birthdate*

MonthDayYear
Is student a US citizen?

YesNo
Does the student have any disabilities?

YesNo
If yes, please specify
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
I. Parent/Guardian Data

Tell us about yourself
Full Name*

First NameLast Name
Full Name*

First NameLast Name
Mobile No*
Mobile No*
Email *
Where the confirmation will be send to
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Annual combined household income

Less than $60,000More than $60,000
Does the parent/guardian have any disabilities?

YesNo
If yes, please specify
Number of people in household

23456 or more
Why do you want to be selected to be a part this program, and how do you believe it will benefit you?

0/300
Have you submitted a previous application?

YesNo
Do you have reliable transportation?

YesNo
Are you able to attend lessons 4 days per week?

YesNo
Please upload proof of household income (tax return or pay stub) and proof of residency (utility bill)

Cancelof
VIII. Applicant's E-Signature
By signing below, I confirm that the information provided is accurate and complete to the best of my knowledge. I understand that failure to meet the commitment requirements may result in forfeiture of the scholarship and repayment of lessons

When you press the submit button, you will receive an email confirmation that your application was received. Please print for your records and retain as verification of your application.
Signature

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Swimming to Survive is committed to equal opportunity. This organization does not discriminate in any program or activity on the basis of race, color, religion, gender, age, national origin, disability, marital status, or any other protected class.
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swimming to survive scholarship application

I. Student Data

I. Parent/Guardian Data

VIII. Applicant's E-Signature