Helping Hand Funding Application Form
All sections of the application must be filled out completely.
First name *
Last name *
Email *
Phone Number *
Address *
Number of Children in Home (Under 18) *
Number of Adults in Home *
Relationship to Child: *
Child Name (First, Last) *
Birthdate *
MM
/
DD
/
YYYY
Age *
Gender *
Sport *
Sport Organization Name & Address *
Contact Name *
Sport contact email *
Sport contact Phone *
Program start date *
MM
/
DD
/
YYYY
Program end date *
MM
/
DD
/
YYYY
Total Fee requested (UP TO $250/ year/ athlete) *
Please indicate what funding support is required for: *
Total Yearly Household Income *
How did you hear about us? *
Required
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