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SCHOLARSHIP APPLICATION
SCHOLARSHIP APPLICATION

SCHOLARSHIP APPLICATION

First Name*

Last Name*

Company

Address*


City*

State*
Postal Code*

Country*
Email*

Day Phone*

Evening Phone

Is scholarship for a child age 10-17?  If so, provide name of child:

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.
Are you currently employed?

Are you currently employed?

Employer Name

Employer Name


Employer Phone

Employer Phone


Please check appropriate annual household income:

Please check appropriate annual household income:

Why do you want to participate in this program?

Please check the SCUBA Certifications that you currently hold.  Before becoming a dive volunteer, your certification cards will need to be confirmed.
Upload Image of You (Optional)

Upload Image of You (Optional)

Click to upload a file
Please upload essay (100-300 words) Why is SCUBA important to me?

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

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.
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