Name

Age

Name of Parent/Guardian (If applicant is a minor.)

Email of Applicant (If applicant is a minor, email of parent or guardian.)

Phone Number of Applicant (If applicant is a minor, phone of parent or guardian.)

Address 1

Address 2

City

State

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Zip Code

What are you hoping to achieve from participating in Outdoor Afro’s swim scholarship? How would the swimmership benefit you?

Please explain why you would like to be considered for an Outdoor Afro Swimmership. Include any special circumstances (i.e. medical bills, student loan debt, financial hardship, disability, cultural barriers, etc.)

Have you previously taken swim lessons or participated in another swim program? Yes or no. If yes, please list.

If granted a swimmership, where will you take lessons? You must enter the name of an organization.

Website of organization

Name of contact at the organization

How much do the lessons cost? You must have spoken to the organization and provide the exact cost.

How long is the swim program?

When does it start?