HCDC Dive On Into 2024 Scholarship Application Form

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Dive On Into 2024 Scholarship
USA Diving Anthony Taylor Foundation Grant Recipient 2024

With the continued support of the Anthony Taylor Foundation and the HCDC coaching staff we are grateful to be able to continue to offer scholarships for the 2024 USA Diving Season with our Dive On Into 2024 program. These scholarships are made possible through the generous support of USA Diving & Hastings Community Diving Club LLC.

This form includes the expectations and income guidelines for diver athlete scholarship applicants. This scholarship is for community members under the age of 18 who currently fall under the reduced meal/free meal and medicaid programs.

If approved, recipients will be required to complete a registration form and waiver for Hastings Community Diving Club that includes an annual USA Diving membership fee. Please email Head Dive Coach, Todd Bates if you have any questions @ toddbates@att.net.

This scholarship form will be reviewed after a photocopy of a supporting financial document has been received. Please submit supporting financial document to: toddbates@att.net or in person.

Eligible documents are: most recent federal tax return, public assistance documentation, medicaid card, free/reduced lunch determination letter or proof of unemployment (photocopies only, will not be returned). You will receive a decision letter once your application has been reviewed.

Email *

Record my email address with my response

Student Athlete Name: *

Age: *

Date of Birth: *

YYYY

Home Address (include city & state): *

Main Phone Number / Cell: *

School & Grade: *

School District: *

Parent/Guardian Name: *

Why are you interested in joining Dive Club?: *

Diver Athlete lives with: *

Both Parents

Parent/Step-Parent

Grandparent (s)

Foster Parent

Single Parent

Diver Athlete housing situation: *

Own

Rent

HUD Section 8

Diver Athlete's Race/Ethnicity (please check all that apply): *

Caucasian

Hispanic

African-American

Asian

Native American

Other

Other:

Required

Diver Athlete annual household income *

Less than $15000

$15,000 - $29,000

$30,000 - $49,999

$50,000 or above

Other:

Diver Athlete receives these government assistance programs (please check all that apply) *

FIP/TANF (Family Independence Program)

RAP (Refugee Assistance Program

SSI (Supplemental Security Income)

SDA (State Disability Assistance)

UI (Unemployment Insurance)

FAP (Food Assistance Program)

Free/Reduced Price Lunch Program (provide documentation)

Healthy Kids/MI Child

Medicaid

Other:

Required

By typing my name below, I commit to regular attendance at dive club. *

Today's date: *

YYYY

Documentation to support scholarship application (email proof to toddbates@att.net or in person): *

A copy of your responses will be emailed to .

Submit

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