Spirit Club Foundation Scholarship Application

In order to be considered for a scholarship from Spirit Club Foundation, the following eligibility criteria must be met:

1. Applicant must demonstrate a financial need for a scholarship

2. Applicant must have a diagnosed disability

3. Applicant has reliable transportation to and from exercise program

4. Applicant agrees and understands scholarship recipient data collection requirements

5. Applicant understands 6-month scholarship term

Please select the scholarship option you are applying for *
All scholarships are for 6-month terms, beginning on the day of the first scheduled session
Have you applied for a scholarship from Spirit Club Foundation in the past? *
Applicant Name (First & Last) *
Your answer
Applicant Email *
Your answer
Applicant Phone Number *
Your answer
Mailing Address *
Your answer
Applicant County of Residence *
Date of Birth *
MM
/
DD
/
YYYY
Please select the applicant's mode of transportation *
If applicant selected "Other", please explain applicant's mode of transportation below
Your answer
Ethnicity (optional)
Employer (if applicable)
Your answer
Diagnosed Disability *
Your answer
Applicant Height *
Your answer
Applicant Weight *
Your answer
Please identify a goal you would like to achieve through your participation in an exercise program *
If the applicant has any additional goals or pertinent information, please explain below
Your answer
Applicant Gross Monthly Income ($) *
Your answer
Applicant sources of income *
Required
If applicant selected "Applicant has no sources of income" or "Other" above, please explain
Your answer
Please select any monthly expenses of the applicant *
These are expenses that are not covered by other programs (e.g. insurance, provider, Special Needs Trust, ABLE account)
Required
If the applicant selected any monthly expenses above, please provide an explanation along with the associated monthly cost of that expense.
Your answer
Applicant sources of funding support *
Required
If applicant selected "Does not receive funding support" or "Other", please explain
Your answer
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