Gulf Swimming Coach Assistance Fund Application
To receive health care financial assistance from Gulf Swimming, you must:

1) be an active Gulf Swimming COACH member
2) be employed by a Gulf Swimming swim club (full or part time)
3) be willing to share the following personal and financial information

If you can say "yes" to these three conditions, please fill out form below.

Review and processing of application will take at least 5 business days from submittal of application.  Copies of bills for which assistance is needed MUST BE PROVIDED. (details for bill submittal in this form)

Failure to complete the entire form may delay the review of your request.  

If you have any questions during this process, please contact Gulf's executive director, Julie Bachman, at julie.bachman@gulfswimming.org OR (

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Email *
Applicant's  Legal Name *
Family Information *
Yes
No
Spouse
Children
Number and Age of Children *
Address (street, city, state, zip) *
Phone Number *
Swim Club Employer (name of club) *
How long have you worked for this swim club and in what capacity? *
Salary/Hourly Wage *
Do you have another job(s)? *
If yes to above, please provide employer information (name of employer, job role, salary)
Does your spouse work? *
Spouse Employment Information (if "yes" to above)- name of employer, salary)
Have you received assistance from another agency during the past 6 months? *
If "yes" to above question, please provide details. (name of agency, amount/type of assistance)
Total Monthly Wages for your family *
Current Checking Account Balance *
Current Savings Account Balance *
Investment Balance *
Retirement Account Balance *
Available Cash as of Today *
Please describe your need: *
Please email bills for which assistance is needed to thasz1@gmail.com- check below to confirm you've sent the information. *
Required
A copy of your responses will be emailed to the address you provided.
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