Dive Therapy Program
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District Of Columbia
Is scholarship for a child age 10-17? If so, provide name of child:
Input Birthdate of Individual Applying: Month Day, Year (ex. April 4, 1994)
Please check the box that applies to you.
Military Personnel (Active Duty)
Military Veteran (Honorably Separated)
What is your ethnicity?
This is not used in eligibility, strictly for tracking individuals served through the program. Please indicate how you identify as far as your ethnicity? (Ex. African-America, White, Latina/Latino, Black, Caucasian, Japanese, Korean, Asian, etc. - We realize some of these are redundant, but want to know your preferred term which is why there are no checkboxes.)
Are you currently employed?
Please check appropriate annual household income:
$15,001 - $25,000
$25,001 - $40,000
$40,000 and up
Why do you want to participate in this program?
Have you been diagnosed with a disability?
If yes, please describe.
Please check the SCUBA Certifications that you currently hold. Before becoming a dive volunteer, your certification cards will need to be confirmed.
Open Water SCUBA Diver
Advanced Open Water SCUBA Diver
Buddy Disability Trained Diver
Emergency First Responder
Please indicate which courses/programs you are looking to participate in/ scholarship value you are looking for.
Open Water SCUBA Diver/ $800
Advanced Open Water SCUBA Diver/ $700
Rescue Diver/ $600
Buddy Disability Trained Diver/ $750
Emergency First Responder/ $500
Kids SCUBA Camp/ $2,270
Diving Therapy Program/ $12,000
Upload Image of You (Optional)
Click to upload a file
Please upload essay (100-300 words) Why is SCUBA important to me?
Click to upload a file
Where would you prefer to complete your training? (County, State)
If a scholarship is approved, any training provider and program MUST be approved by
AQUANAUTS ADAPTIVE AQUATICS.
If you have a preferred provider, please list the name and contact information here. We will attempt to accommodate your request, however, they must meet our stringent training requirements.
Terms and Conditions
In applying for a scholarship through AQUANAUTS ADAPTIVE AQUATICS, I understand that I am giving AQUANAUTS the authorization to verify my personal and financial information. I further understand that if I am granted a scholarship through AQUANAUTS, it will be paid directly to the training provider. I understand that my application serves as approval for my essay and/or image to be used in soliciting donations for Adaptive SCUBA Programs.
Also, if granted a full or partial scholarship for Buddy Disability Training or HSA Instructor Training, in the first year I am required to participate in 6 AQUANAUTS non-profit activities once training has been completed or I will be retroactively responsible for the full cost of my training.
By submitting this application, I am affirming that I understand and agree to all terms herein.
I have read and accept these terms and conditions.
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All prices in US Dollars
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