DiverSeaFy Student Application
Thank you for your interest in DiverSeaFy! Please fill out the application below in its entirety. In addition to this Google form, we also require the following:

1. A 250-word (max) response explaining why you’re interested in scuba diving/the ocean and what makes you a great candidate for the DiverSeaFy grant.
2. A letter of recommendation from an adult that would advocate on your behalf (this could be a teacher, administrator, coach, adult family member, etc.).

Please email your responses and letters of recommendation to diverseafy.info@gmail.com

To participate in the scuba course you will have to complete a 10-minute tread/float and a 200-meter untimed swim. Please be honest with your swimming level. If you are not yet confident that you can complete these requirements, please still fill out the application. We will coordinate swimming lessons at a local pool so you can participate in the program when you are ready!

We'd also like to clarify that during this time in our country, with so much emphasis on social justice and creating more opportunities for underserved communities, we are focusing on providing this opportunity specifically to black and brown students. However, we still encourage all to apply, as we will look to expand our reach to other demographics going forward.

Applicants will need to speak with their parents/guardians before submitting this application, as there are two questions at the end that require their attention. DiverSeaFy will provide answers to any questions students or parents may have. Feel free to email diverseafy.info@gmail.com for more information.
Sign in to Google to save your progress. Learn more
Full Name *
Date of Birth *
MM
/
DD
/
YYYY
Email *
Street Address *
Apt./Unit #
City *
Zip Code *
Phone Number *
Emergency Contact Name *
Emergency Contact Phone Number *
Emergency Contact Email *
Name of School *
Year in School *
On a scale of 1-5 (1=Not Confident, 5=Very Confident) how confident are you that you will be able to complete the swimming requirement of the course (10 minute tread/float, 200-meter untimed swim)* For reference, 200 meters is out-and-back two times in an Olympic sized swimming pool *
Not Confident
Very Confident
How long has it been since you last swam? *
Sex *
Ethnicity - Please let us know how you identify *
(FOR PARENTS/GUARDIANS) Please review the next two questions with your parent/guardian
Vaccine Status
Being unvaccinated does not exclude you from the program but you will be required to either present a vaccination card, or if unvaccinated, present a negative PCR test that was taken at max 48-hours before each course activity (there are at least four days that we will meet in person).
Are you fully vaccinated? *
If awaiting first or second dose, when is your next vaccine scheduled?
MM
/
DD
/
YYYY
(FOR PARENTS/GUARDIANS) Are you willing to sign a waiver allowing DiverSeaFy to use photos and videos of your child participating in scuba certification course for promotional purposes? - *Being able to share content from your child's experience will greatly improve our ability to fundraise for future students.* *
How did you hear about DiverSeaFy? *
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy