AM3N Financial Assistance Application

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AM3N is a nonprofit organization that is dedicated to creating generational change through athletic opportunities for those needing financial assistance. We are committed to serving community members regardless of age, race, ethnicity, religion, or gender. Financial assistance and fee reductions are available on a case-by-case basis depending on your application and AM3N financial resources.

If you are interested in applying for financial assistance, please complete the application below and supplement it with proper income documentation (plus whatever other documents apply to you). Application information will remain confidential.

Email *

Record my email address with my response

Applicant's First Name *

Applicant's Last Name *

Applicant's DOB *

YYYY

Applicant's Street Address *

Applicant's Street Address Line 2 *

Applicant's City *

Applicant's State *

Applicant's Zip *

Applicant's Phone *

Applicant's Email *

Parent/Guardian First Name *

Parent/Guardian Last Name *

Parent/Guardian Street Address *

Parent/Guardian Street Address Line 2 *

Parent/Guardian City *

Parent/Guardian State *

Parent/Guardian Zip *

Parent/Guardian Phone *

Parent/Guardian Email *

I/We are applying for financial assistance to help cover costs of: *

Monthly training subscription

AM3N Team Costs

Tournament Fees

Uniform Fees

Employment Status *

Employed

Not currently employed

Occupation or Job Title *

Name of supervisor and phone number *

How many dependent children? Dependents (up to age 26) must reside at the same address. *

Your Finances

Please describe your current and past financial situation.

Your income from last year *

Child support you received last year *

Social security payments you received last year *

List any income you received from other sources (rent, support from relatives, etc.) *

Your total income last year *

Your estimated total income for this year *

Are you receiving financial assistance from any government or local agency? *

Yes

Describe any extraordinary expenses or special circumstance that you are dealing with. Be specific regarding costs and duration.

Additional Documentation

In addition to completing this online form, we will also require the following documents as a part of your application.

Please check the box for each document you will provide. *

Copy of your most recent 1040 form

Your two most recent pay stubs

Disability Letter (if you are receiving disability)

Social Security award letter (if you are receiving Social Security)

An unemployment statement (if you are receiving unemployment)

Required

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