FINANCIAL ASSISTANCE APPLICATION/AGREEMENT

Havasu Stingrays Swim Team

The Havasu Stingrays Swim Teamʼs Board of Directors strongly believes that all individuals should have the opportunity to participate within a competitive swimming program regardless of their ability to pay. Any information provided during the application process will only be used to determine eligibility for assistance and will be held to the strictest confidence.

In an effort to provide the necessary support to those experiencing financial difficulties, the HSST financial assistance program consists of two tiers:

● Tier One: HSST will reimburse the member for their annual dues and will cover 50% of the monthly membership dues. For this tier, the family does have to be within the federal poverty level and provide all the required documents listed below for proof of financial need.

● Tier Two: HSST will cover 50% of the monthly members dues. For this tier, the family must provide proof of financial need by submitting the required documents listed below.

DOCUMENTATION REQUIREMENTS

In addition to this HSST Financial Assistance Application/Agreement, please include the below documentation with your application to provide proof of need. Supporting documents are required for approval and additional information may be requested. Please provide one of the following:

• ●  Any assistance letters (recent SSI, government assistance award letter, disability checks, food stamps, unemployment, free/reduced lunch, etc. )

• ●  Letter of explanation of sudden or extenuating circumstances
  AND please provide proof of household income (last two paychecks, W2 or federal tax returns with social security numbers blacked out).

APPROVAL PROCESS

1. The financial assistance application and required supporting documents will be reviewed.

2. Applications will be approved, denied or more information may be requested. Tier One applications

   may take up to 30-days for approval and Tier Two may be approved within 48 hours.

3. Notification will be sent aer review by email to the applicant.

AGREEMENT ACKNOWLEDGEMENT

• ●  I/we understand that this financial aid will be considered effective as of the date of this application.

• ●  I/we understand that our account must be kept up-to-date, no outstanding balance beyond 30-days.

• ●  I/we understand that our family is required to participate in the HSST fundraising opportunities.

• ●  I/we understand our swimmer(s) are required to maintain regular attendance at swim practices.

  Swimmers are expected to attend a minimum of 70% of all scheduled practices. * If extended

  absences are needed, please arrange with the Head Coach.

• ●  I/we understand that our swimmer(s) are required to attend any HSST sponsored home meets and are

  strongly encouraged to attend other meets when possible.

• ●  I/we understand that adult members of our family are required to contribute 10 hours of volunteer

  service to the team as outlined in the Family Participation Program.

• ●  I/we understand that financial aid is awarded for the duration of the current season only. I/we agree to

  reapply in subsequent seasons if we are still in need of financial assistance.

• ●  I/we agree to notify the Board of Directors as soon as our circumstances change and assistance is no

  longer needed so funds can be allocated to another family in need.

  APPLICANT INFORMATION

  Swimmerʼs Name(s): __________________________________________________________________________ Swimmerʼs Group (s): _________________________________________________________________________ Grade In School: __________________ Name of School: _____________________________________________

  Parent/Guardian Name: ______________________________________ Phone: __________________________ Marital Status: ⬚ Single ⬚ Separated ⬚ Divorced ⬚ Married
  Occupation: ________________________________________________________________________________ Employer: __________________________________________________________________________________ Billing Address:______________________________________________________________________________ Email: _____________________________________________________________________________________ Financial Assistance Requested: ▢ Tier One ▢ Tier Two

  By signing below: As the responsible parent/guardian for the swimmer(s) named above, I/we have read and agree to be responsible for meeting all of the above requirements for the Havasu Stingrays Swim Team financial assistance program. Furthermore, I/we understand that failure to meet the requirements of this application/agreement may be the cause for the revocation of our financial assistance.

  Parent/Guardian Signature:____________________________________________________ Date: ________

Created 2017, Revised & Approved 10242022

To be filled out by parent/guardian or swimmer: Please explain below why you think your swimmer(s) would be a good candidate to receive financial assistance from HSST (e.g. their dedication/character/work ethic, why the swimmer want to swim, how theyʼll demonstrate their commitment to the sport/team, etc.): ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________