EmailMe Form - SJAC Financial Assistance Application

Parent(s)/Guardian(s) Information

Name *

First Last

Email *

Phone *

### - ### - ####

Are you currently serving in or a veteran of the U.S. Military? *

Yes

No

Address *

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

Which SJAC program are you applying to? (Please choose only one) *

SJAC Swim School

SJAC Team

How many adults currently reside in your household (including yourself)? *

1

2

3

4 or more

How many children (under 18) currently reside in your household? *

1

2

3

4 or more

How many of you children would be entering swim lessons or the swim team? *

1

2

3

4 or more

Please list the age(s) of the child(ren) in your household. *

What is your total annual household income? *

Has there been a major life change that has lead you to apply for financial assistance that would not show up on your 1040 tax form? Please explain to the best of your ability. If not, write N/A *

Please upload the first page of your 1040 tax form: *

Swimmer(s) Information

Financial Assistance is limited to 2 swimmers/household.

Name

First Last

Name

First Last

Date of Birth

MM / DD / YYYY

Date of Birth

MM / DD / YYYY

Address (if different from above address)

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