CONFIDENTIAL APPLICATION FOR FINANCIAL AID
Financial Aid is available on a limited basis & is awarded primarily on need.
Date
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Month
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Day
Year
Date
Applicant Information:
Name:
*
First Name
Last Name
Organization:
Date of Birth
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Month
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Day
Year
Phone Number:
*
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Area Code
Phone Number
Email:
*
example@example.com
Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Occupation
Annual Family Income (please check one)
Under $15,000
$15,000-30,000
$30,000-50,000
$50,000-80,000
$80,000-150,000
$150,000-200,000
$200,000+
Do you rent or own your home?
Rent
Own
Number of individuals in household?
Does family receive assistance for day-to-day living from any other source?
Provide brief description of special project or program you are requesting funds to help support. Please include- specific audience, ages, number of participants, start & end date and primary goals.
*
Please explain why you need Raise A Racquet funds for this program or special project.
*
Please list specifically what expenses for which you will be using the aid:
*
Budgets, Bids and/or photos
Browse Files
Upload documentation
Cancel
of
Total Dollar Amount Requested
*
Date aid is needed by:
*
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Month
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Day
Year
Date
Receipts must be submitted to verify expenses.
Signature
*
Typed Name represents signature
Date
*
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Month
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Day
Year
Date
Submit
Should be Empty: