Summit Scholarship Application

Summit Scholarship Application

Snow and Summer Sports
Welcome! Summit Adaptive Sports is offering scholarships for lessons for individuals in need of financial assistance.
- More information about our programs can be found on our website at summitadaptive.org
- If you need assistance filling out any of these forms, please contact Summit Adaptive Sports at summitadaptivesports@gmail.com . Our staff will be happy to assist you!
- If you live more than a 2 hour drive away from Ski Sundown please indicate why you would like to ski, snowboard or participate in our summer sports with our adaptive program (e.g. visiting family in the area, closest location to me for a day trip, etc..) in the space provided at the end of the application.
Note: No monetary awards are sent. You will be notified of a scholarship award and be directed to either call Ski Sundown's Welcome Center to book the snow sport scholarship lessons or how to register for summer sports.
Name of person completing the application : *

First NameLast Name
Connection to the Participant *
Please specify: self, parent/guardian, spouse, other family member such as sister/brother, friend, aide, etc..
Has a Participant Registration Form been completed this year for the individual seeking the scholarship?*

YesNo
Every individual requesting a scholarship must complete a Participant Registration Form each year. Please follow this link and complete the form BEFORE you apply for a scholarship.

Participant Registration Form

Once you have completed the Participant Registration Form please return to the Scholarship Application.
PARTICIPANT INFORMATION
Participant requesting scholarship: *

First NameLast Name
Participant's Date of Birth *

MonthDayYear
Date
Participant's Gender Identification
Please specify: male, female, non-binary, etc.. or preferred pronouns
Participant's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Best Phone Number to contact?*
Please enter a valid phone number.
Who is this number for?

ParticipantPerson completing the application (if different from the participant)
Best Email to contact*
example@example.com
Who is this email for?

ParticipantPerson completing the application (if different from the participant)
Has the participant applying for the scholarship served in the U.S. Military?*

YesNo
Has the participant been involved in an Adaptive Sports Program Before?*

YesNo
If yes, please list program(s) .
Has the participant been involved with Summit Adaptive Sports before?*

YesNo
Has the participant received a scholarship from Summit Adaptive Sports before?*

YesNo
If yes, when?*

MonthDayYear
Date
Has the participant received any other adaptive sports scholarships for this year (winter or summer sports) ?*

YesNo
Are there any family members in your household who ski, snowboard or participate in the sport you are requesting a scholarship for?*

YesNo
In a brief paragraph, tell us how a scholarship with Summit Adaptive Sports will be beneficial the intended recipient.*
Primary Disability*
Secondary Disability *
If none, type N/A
Based on the information on the participant's disability we may need to contact you for additional information to assess equipment needs.
INCOME & FINANCIAL INFORMATION
Is the participant :*

A StudentEmployed (if over 18)Not Employed (and over 18)
Name of employer:
Number of individuals living in the household the participant resides:*
Of the individuals living in the household, how many are under 18 or legally conserved?*
Annual household income range of the household in which the participant resides:*

Under $50,00050,000-100,000100,000- 150,000200,000 PlusPrefer not to answer
Estimated annual out of pocket healthcare expenses, related to disability:*
Amount you can contribute towards lessons (per lesson)?*
Is there any other information regarding your income or financial needs we should be aware of?
SCHEDULING INFORMATION
What sport are you requesting scholarship assistance for:*

Ski (including bi-skiing or mono-skiing)SnowboardKayakingMountain Biking
How many times would you like to ski, snowboard with Summit Adaptive this season:*

Just once to try it2-3 lessons4-5 lessons
Days of week available for lessons (check all that apply):*

Monday 3:00Monday 5:30Tuesdays 4:00 (kayaking specific)Wednesday 3:00Wednesday 5:30Thursday 3:00Saturday 9:30Saturday 1:00Sunday 9:30Sunday 1:00
If other, please explain.
Will you be submitting additional scholarship applications for other participants?

YesNo
If Yes, Please list their names in the space below:
Is there any other information you would like to add? If you have greater than a 2 hour drive to our program please use this space to explain why you are choosing to apply for a scholarship to Summit Adaptive and come to Ski Sundown, e.g. visiting family or friends, closest day trip for you, etc..) or one of our summer sport events?
By checking the box and signing below I confirm that the information is the most current and accurate. I understand that it is my responsibility to inform Summit Adaptive Sports regarding any changes to my 1) contact information such as address, phone, and email and 2) any medical conditions including new diagnosis, surgery or medical changes that may impact my or my family member's participation in a lesson or program.*

Yes, I confirm the above
Signature*

Clear
Type name of person signing this application*
Today's Date*

MonthDayYear
Date
Please verify that you are human*
Should be Empty: