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The Premier Swim and Aquatics Club
Scholarship Application Form
First and Last Name of Person Completing this Request
*
Athlete First Name
*
Athlete Last Name
*
Email
*
Phone
*
Address
*
Scholarship Needed for
*
Dues (2 months)
Meet Fees (1 meet)
USA Swimming Membership
Reason for scholarship request
*
How will you continue after scholarshp has been fulfilled?
*
Household Annual Income
*
Less than $40,00
$41,000 - $80,000
$81,000 - $100,000
Over $100,000
Number of Club Sports other than swimming athlete is involve in year-round
*
Submit
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