TAS Scholarship Application
Please fill out the following form as thoroughly as possible to help us determine if you qualify for a TAS scholarship.
What is your name (if you are applying on behalf of someone else)?
Are you applying on behalf of an individual, family, or a group? Select
Name (of participant)
What is the total cost of the program the participant, family, or group will engage in?
What is the total percentage of scholarship being requested by the participant, family, or group will engage in?
50% of the total covered by TAS scholarship
25% of the total covered by TAS scholarship
Who is your current employer? (of the person who takes care of the finances)
What is your current job title?
How long have you been with your current employer?
Are you part of a single parent household?
How many people are in the household?
How many children are in the household?
How many people with different abilities are in the household?
How many family members earn an income in the household?
What is the percent of household income related to long-term medical expenses?
Select any program(s) that the participants, family, or group may currently be receiving assistance from.
Aid for Dependent Children
Brain Injury Alliance of Utah
Free School Lunch Program
Subsidized Living Program/Low-Income Housing
Temporary Assistance for Needy Families
Women Infants and Children (WIC)
List any other assistance programs the participant, family, or group may currently be receiving assistance from.
How will the requested scholarship help the participant, family, or group?
Describe what will be gained by participating in Teton Adaptive Sports programs.
Describe any financial burdens or additional factors that Teton Adaptive Sports should consider when assessing this scholarship application.
Send me a copy of my responses.
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