2021-22 PAC Ellertson Family Scholarship Application

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

PAC Ellertson Family Scholarships are for those who are currently registered with PAC.

This Application is for: *

Monthly Dues Assistance

Annual USA Swimming Registration Fees (USA Swimming requires one of the following: SNAP card letter with date of eligibility, OHP – medicaid letter of approval with date of eligibility, Y or Parks and Rec Low Income membership letter with date of eligibility, Low Income – most current year tax return needed to validate income is equal to or less than the federal poverty line

Travel Assistance

Meet Assistance

One Time Emergency Assistance

Gear Assistance

Required

Swimmer name (last, first)

Pool location(s) *

Training group(s) - If unsure please provide best guess. *

e.g. Silver, Bronze 1 or 2

Name of Parent/Guardian & best contact information *

Email, phone and/or text and best time of day to reach you

Have you received PAC assistance in the past? *

Yes

Provide any information you feel is relevant to the scholarship committee in making their decision. The more information you provide the easier to allocate funds. *

Below, please include your specific dollar request and / or how much you are able to afford. This is helpful for the committee when distributing limited funds. *

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Portland Aquatic Club. Report Abuse

Forms