Portland Financial Assistance Application

Financial Assistance Application

Skate Like a Girl Portland
Skate Like a Girl Portland is committed to providing access to programs to all people in our community. Skate Like a Girl welcomes people of all ages, races, ethnicity, religions, abilities, and socioeconomic backgrounds.

FINANCIAL ASSISTANCE

Based on established guidelines and to the extent possible, Skate Like a Girl provides Financial Assistance to anyone desiring to participate in our programs, events, and other activities. While we are committed to serving everyone, we depend on membership and program fees, volunteers, and donations to support our services.

Who is eligible for Financial Assistance?

Anyone is eligible to apply for Financial Assistance. Awards are based on a sliding scale that considers household size and income. Extenuating circumstances, including extraordinary economic challenges, may also be considered.

How is the amount of Financial Assistance determined?

Financial Assistance is awarded on a percentage basis based on federal guidelines issued by the United States Department of Health and Human Services. These guidelines take into account the household size and income of all household members.

How long does Financial Assistance last?

Financial Assistance is granted for a defined time period of 1 year after the first day assistance begins. After this period, applicants may reapply.

HOW TO APPLY FOR FINANCIAL ASSISTANCE:

1. Complete the Financial Assistance application below. List all individuals residing at the household address, regardless of whether they will or will not be participating in Skate Like a Girl programs.

2. Include documentation of all sources of income for all household members, regardless of whether they will be participating. Acceptable forms of documentation include:
- Documentation of child recieving Free or Reduced Lunch at school
- Two months of recent pay stubs from an employer
- Current unemployment benefits statement
- If self-employed, current profit and loss statement or balance sheet and two months of bank statements
- Child Support verification 
- SSA or SSI award letter 
- Statement of monthly pension, annuity, and/or all other retirement income
- DSHS or TANF award letter detailing cash and food assistance, including the household income page (supplemented with other income or work source letter)
3. You will hear back about the status of your application within 15 business days via email, including instructions on how to register for programs. If you do not hear back from us, we may be experiencing a high volume of applications. Please feel free to reach out to confirm your Financial Assistance status if you have not heard back from us.
I have read and understand the instructions *

Yes
General Family Information
Full Name of Applicant (Person filling out this form) *

First Name Last Name
Amount of Assistance you are Requesting:

10% Sibling Discount 25% Scholarship 50% Scholarship 100% Scholarship Unsure Other option
Birthdate: *

Month Day Year
Phone: *

- Area Code Phone Number
E-mail : *
Where the confirmation will be send to

Home Address : *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Participants
Name of Participant *

First Name Last Name
Name of Particpant

First Name Last Name
Name of Participant

First Name Last Name
Documentation of Need
Employment Status of Applicant *

Full-time Part-time Unemployed Student
Total Household Members *
Combined Household Income *
Total Amount of Dependents *
Federal Income Status *

Single Joint Other
Describe your financial situation and any extraordinary challenges that affect the household finances. Examples include medical bills, education expenses, recent changes in employment, etc.
Are you interested in volunteering or providing any other type of trade (products, professional services, etc.) in exchange for Skate Like a Girl programs? Please describe.
Have you been approved for Financial Assistance with SLAG in the past?

Yes No
We ask that you provide documentation of need for your family. Please upload your files below. Accepted forms of documentation include:
- Documentation of child recieving Free or Reduced Lunch at school
- Two months of recent pay stubs from an employer
- Current unemployment benefits statement
- If self-employed, current profit and loss statement or balance sheet and two months of bank statements
- Child Support verification 
- SSA or SSI award letter 
- Statement of monthly pension, annuity, and/or all other retirement income
- DSHS or TANF award letter detailing cash and food assistance, including the household income page (supplemented with other income or work source letter)
Optional Survey

The information is requested for post-scholarship report generation only and in no way affects your selection for your award. The data we collect on financial assistance recipients helps us articulate to future funders the importance of donating to support scholarships and assistance to families like yours.
Gender of participant(s)

male female gender non-conforming
Age of participant(s)

5 & Under 6-11 12-17 18 & Up
Language(s) Spoken at Home
Race (Choose one or more):

African American Alaskan Native American Indian Asian Black Caucasian Hawaiian Latino Middle Eastern Mixed Race Pacific Islander Other option
Ethnic Identity of participant(s)
E-Signature
By signing (typing your legal name) in the space below, you are certifying that all information is correct and that you are the person completing this application. 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.
E-Signature: *
E-mail
Should be Empty:

Financial Assistance Application

General Family Information

Participants

Documentation of Need

E-Signature