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Application for Scholarship

Name

Date of Birth

Gender

Height

Weight

Race Demographics

Address

City

State

Zip Code

County

Phone/Mobile

Email Address

Parent/Guardian Details

Secondary Parent/Guardian Details

School

What Sailing Program are you requesting assistance for?

Summer Sailing Program - Morning Session

Summer Sailing Program - All Day

Please provide the % of financial assistance you are requesting.

Please provide your household's total adjusted gross income from last year as reported on your IRS tax return.

Proof of Household Income (last year's IRS tax return - form 1040 or similar)

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Pay Stubs (last two months)

Upload File(s)

All Other Forms of Income and Financial Assistance (As part of the application process, you are required to provide documentation for all other forms of income and financial assistance received by the Parent(s)/Guardian(s) and the program participant, including but not limited to: alimony, child support, disability, welfare, unemployment, scholarships, or grants.)

Upload File(s)

Please list or describe any additional circumstances for scholarship consideration.

I certify that all information provided is accurate and true to the best of your knowledge. You also certify that you understand that providing false or misleading information may result in the denial or cancellation of financial assistance.

Yes

Any information provided within scholarship application is confidential.

Parent/Guardian's Signature:

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Parent/Guardian’s Name

Participant’s Name

Date / Time

814-566-5386

4307 13th Street West Palmetto, FL 34221

[email protected]

Apply for Scholarship