Individual Recipient Application

The application deadline for the 2017 dance has now passed. Any applications received will be saved for the 2018 dance.

All information must be filled out completely for the application to be accepted.

The information provided is strictly confidential and is for the use of the South High Marathon Dance only. The SHMD Committee will meet at the beginning of January to review all applications. Any application received after January 3, 2018 will be placed on file for consideration during the review process the following year. Applications will be considered incomplete and will not be reviewed unless all requested information is provided.

    Recipient Information

    All information in this section must be completed. This application will not be reviewed if all information is not filled in. Please refer to the recipient when completing this section of the application.
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    Medical Information

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    Health Insurance Information

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    Household Financial Information

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    Financial Assistance Needs

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    Information on the Person Making the Nomination

    Please refer to the person making the nomination when completing this section of the application. Any questions about the application will be directed to this phone number and/or email address.
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