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Scholarship Application

AquaChamps Swim School (ACSS), in conjunction with Every Child A Swimmer (ECAS) and Florida Swimming Pool Association Broward Chapter (FSPA), provides scholarships to swimmers who are in financial need of assistance for swimming lessons.

Qualifications include:

Must be at a “learn to swim” level.
Ages 3-9.
Must be able to prove (with SNAP, WIC, Medicaid, foster family card, or most recent tax return) financial need by meeting the current income eligibility guidelines.
Applicants may not reapply within the same year (must be 365 days after prior approval).

"*" indicates required fields

Step 1 of 4

25%

Please review and agree to the terms and conditions of this scholarship before starting your application.

I understand that information about my swimmer’s swimming skills may be exchanged between ACSS, ECAS & FSPA.*

I understand

I understand that if I am awarded financial assistance, this program will become a priority and I will commit to swimming lessons during the scheduled period.*

I understand

I understand that swimming skill information and photos may be used with current & potential donors.*

I understand

I understand that photos of my swimmer during swimming lessons/at swimming facility may be used for promotional material.*

I understand

I understand that I have three months from my start date to use my scholarship. After which, funds will be forfeited.*

I understand

All information submitted on this application are true to the best of my knowledge.*

All Information Is Accurate

Parent/Caregiver Name

Date

MM slash DD slash YYYY

First Tell Us About Your Swimmer

Name of Swimmer*

Age*

DOB*

MM slash DD slash YYYY

Swimmer's Race*

Parent/Caregiver Name*

Parent DOB*

MM slash DD slash YYYY

Email*

Phone*

Mobile Service Provider (T-Mobile, Verizon, etc.), for weather alerts*

Home Address*

City*

State*

Zip Code*

Now Tell Us About Your Swimmer's Abilities

Has your swimmer taken swimming lessons before?*

Yes

No

Do you have a pool at home?*

Yes

No

Does the swimmer have any special needs or medical conditions that we need to be aware of?*

Yes

No

Please explain the special needs or medical conditions.*

Is the swimmer comfortable in & under the water without any floatation devices?*

Yes

No

Can the swimmer swim independently?*

Yes

No

Is the swimmer comfortable in areas of water where they cannot touch the bottom?*

Yes

No

How did you hear about our scholarship program?*

Is there any additional information that you would like to share with us regarding your swimmer’s swimming skills?*

Is your family in need of financial assistance for swimming lessons?*

Yes

No

Does your swimmer/family qualify for the Broward County Free & Reduced-Price Meal program?

Yes

No

Please Upload Proof Of Qualification - Medicaid card, SNAP approval, WID card, or your most recent tax return.*

Max. file size: 2 GB.

Please list the number of people living in your household.

Δ

Please allow two weeks for notification of your application status. We will notify you of your approval or denial via email, and if approved, we will call you to discuss how it works and your scheduling/programming options.

Lesson start dates will depend on schedule availability. Accepting scholarship funds will require a commitment on the part of the parent/caregiver. It is important to complete all scheduled lessons to ensure your swimmer’s success in our program. Any missed lessons/classes will not be rescheduled. All information disclosed within your application will be kept confidential.

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509 NE 43 Street,
Oakland Park, FL 33334

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