TLS Swim1922 Scholarship Application Form
GENERAL INFORMATION
If you have questions about the application form please contact tls.swim1922@gmail.com
Name of Person Completing This Application *
Your answer
Relationship to Student *
Your answer
Student's First Name *
Your answer
Student's Last Name *
Your answer
Student's School *
Scholarship recipients must attend elementary, middle, or high school in Western Wake County (e.g., Cary, Apex, Holly Springs, Morrisville, or Fuquay Varina)
Your answer
Homeroom Teacher *
Your answer
Current Grade *
School Guidance Counselor's name
If selected, the student's Guidance Counselor will be notified of the scholarship. The school will decide if student recognition will be given (for example, acknowledgment in the school newsletter, Awards Day ceremony or other school announcements).
Your answer
Parent/Legal Guardian's First Name *
Your answer
Parent/Legal Guardian's Last Name *
Your answer
Parent's Home Phone Number *
*Parent will be notified by telephone if selected. Either home or mobile phone number is required.
Your answer
Parent's Mobile Phone Number
Your answer
Parent's Email Address *
You will receive confirmation that the application was received.
Your answer
SCHOLARSHIP QUALIFICATIONS
The TLS Swim1922 Scholarship is primarily intended to assist children whose families might not otherwise have financial means for swimming lessons. Does the student qualify on this basis? *
Has student ever taken swim lessons? *
If Yes, when were the lessons taken and where? *
Your answer
If Yes, what is the student's current skill level? *
Your answer
PARENT'S CHECKLIST
Student essay submitted? *
Please ensure the student essay has been written and submitted prior to submitting this application. Link to Essay form: https://goo.gl/forms/X8zdnE3uI56BQYLE2
Publicity Release Form signed? *
Please sign and retain. The signed form will only be collected from scholarship recipients.
Sorority Waiver of Liability reviewed? *
Please review. The signed form will only be collected from scholarship recipients.
If awarded the scholarship, I understand that I must complete the registration process of the swim facility on behalf of my child and additional requirements may apply. *
I agree to ensure student attends scheduled swim lessons. *
I understand that swim lessons may be restricted to particular days and times as determined by the swim facility/instructor. I further understand that a time frame to complete lessons may be imposed by Theta Lambda Sigma or the swim facility. *
SIGNATURE
Parent/Legal Guardian
By checking this box I verify that I am authorized to sign this application for the specified student as parent/Legal Guardian. *
Required
Enter your name below to sign this form. *
Your answer
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