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D2D's ISR Scholarship application 
Please complete this scholarship application to the best of your knowledge. 
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Email *
Parent/Guardian Name *
First and last name
Email *
Phone number *
Address *
List who you are requesting a scholarship for, with age. *
Is your child a returning member? *
Do you have other children who have taken ISR before? *
Have you ever received a scholarship from D2D before? *
Does your child have an intellectual or developmental disability? Please provide information about your circumstances below. *
Please tell us how you've heard about ISR and D2D's Scholarship program. *
Classes are 5 days a week, 10 minutes a day, at the jenison location. Does this work for you? If so, What time frames work best for your family? *
Please list any activities your child participates in.
 *
INCOME LEVEL
This information is optional. If D2D has a waitlist for a scholarship, please be aware that we try to help those most in need first. All information provided stays confidential.
Your employment information (include employer,
occupation, length of employment, supervisor's name and number, and weekly hours)
Your spouse/partner's employment information
(include employer, occupation, length of employment, supervisor's name and number, and
weekly hours).
Annual Income Level
Household size
Other Income (child support, public assistance, etc).
Does your child qualify to receive free or
reduced lunch in school?
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What is the financial contribution your family can afford towards the ISR cost?
After you complete your session, it will be your responsibility to pay $10 per maintenance class.The instructor will provide you with how often she feels your child should return for maintenance class (could be once a week, every other week, or even once a month). Is this something you would be able to commit to?  *
AGREEMENTS
Please read through our agreements carefully. Once read, please check " I AGREE" before submitting your application.
I agree that I’ve applied for a self-rescue swim lesson scholarship. I also agree that lessons
meet 5 days per week and that it will take approximately 4-6 weeks for my child to become
skilled. I also acknowledge that illness or different progression rates may extend this
timeline. My child will stay in lessons until the instructor deems that my child is fully confident in self-rescue  skills. We will attend daily lessons with consistency. I agree that unexcused absences will result in my scholarship funding being terminated for the week of
the unexcused absence. In the case of unexcused absences, I will be responsible to pay my
instructor the full weekly tuition ($100).
 *
Scholarship award details are to remain confidential. We hope you will proudly share with others if your family is granted a scholarship; however, award amounts and other particulars are not to be communicated. Failure to keep this confidentiality of your scholarship can
result in removal of your scholarship privileges. D2D shall also keep the information pertaining to you, your child, and your application confidential.
 *
I agree there is a separate registration fee with my swim program provider, which I am responsible to pay. This fee may be covered for those who qualify based on need.
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If you are satisfied with your lesson results, we gently ask for your support by a written parent testimonial following award of scholarship and completion of
lessons, and that we have your permission for its use in our PR and marketing campaign. We appreciate and encourage you to give us shout outs or recognition from your own social media accounts. Your efforts to spread the word about the mission and impact can help touch additional families and save lives!
 *
I agree that to maintain my child’s self-rescue skills and ability to self-rescue, I must enroll in maintenance continuation lessons. I understand that these continuation lessons are not covered under D2D's scholarship. I also agree that D2D's team advises that my child continues with self-rescue swim lessons until it is recommended that they move onto any other type of swim lessons.
 *
I agree that the self-rescue swim program is most effective when taught without outside interference. I understand that my scholarship is only valid if I refrain from outside swimming (swimming for fun with family or other swim lesson types) with my child until
after they become fully skilled.
 *
In addition to completing the appropriate application form, we ask that you provide a written statement explaining your need for assistance, why you feel self-rescue swim lessons are right for your child/children, and your ability to commit to daily lessons with regularity. Your written statement will weigh heavily in the decision-making process. If you are not
comfortable writing, please include a brief statement and supplement it with a letter of recommendation. Please write your statement below. 
 *
I agree that portions of my written statement may be used in D2D's educational outreach and communication with supporters. Please note, D2D will never use the names of our swimmers or families in these materials or communication. If there are portions of
your written statement that you wish to remain confidential, please contact - 
Alicia Mathieu @ Down2defend@gmail.com 
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I agree that all photos and videos taken of my child during ISR lessons are able to be used on D2D'S website and social media accounts for marketing purposes.  *
We count on our scholarship families to help us pay it forward. Please check all the ways
that you're willing to support our mission:
 *
Required
If you chose "Other" to the above question, please explain.
Signature - by writing your name here you agree to all terms of this scholarship agreement.
 *
A copy of your responses will be emailed to the address you provided.
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