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Live Like Jake Foundation
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    • About Us
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Application

Parent-Legal Guardian Information

Parent-Legal Guardian Name(Required)
MM slash DD slash YYYY
Parent-Legal Guardian Email (all communication will go here)(Required)
Parent-Legal Guardian Address(Required)
Do you own or rent your home?(Required)
Spouse-Partner Name
MM slash DD slash YYYY
Spouse-Partner Email
DROWNING IN THE FAMILY(Required)
*HAS YOUR CHILD EXPERIENCED A DROWNING, EITHER FATAL OR NON-FATAL (THAT REQUIRED AT LEAST ONE-NIGHT IN HOSPITAL) ? MUST BE YOUR CHILD; NOT A RELATIVE.
IF THE ANSWER IS YES, PLEASE INCLUDE DETAILS OF THE EVENT LIKE NAME OF CHILD, DATE OF EVENT, AGE OF CHILD, CIRCUMSTANCES OF THE DROWNING.

Legal Dependents

Click "Add Dependent" button to add each child
Row ID Legal Dependent Name Date of Birth Legal Dependent Gender Will Legal Dependent Receive Lessons? Legal Dependent New or Refresher Course?Actions
      
There are no Dependents.

Maximum number of dependents reached.

Employment Information

Employers
Please list your employer's information.
Employer
Supervisor
Employer Phone
Length of employment
Position
Weekly Hours
 
Spouse-Partner Employers
Please list your souse-partner employer's information.
Employer
Supervisor
Employer Phone
Length of employment
Position
Weekly Hours
 
IMPORTANT: ENTER GROSS MONTHLY AMOUNT BEFORE TAXES HAVE BEEN TAKEN OUT. NOT YEARLY & NOT NET.
FILED TAXES LAST YEAR?(Required)

General Information

Ever received Scholarship from Live Like Jake?
Have you ever received a scholarship from the Live Like Jake Foundation, Inc.?
Lessons Time Preference(Required)
PERMISSION FOR CHILD'S NAME IN PHOTOS(Required)
PLEASE INDICATE IF WE MAY IDENTIFY THEIR NAME OR NOT.
Have you taken a vacation/trip in the last 6 months?(Required)
Are you planning a vacation|trip in the next 6 months?(Required)
Do you currently have annual passes to any theme park?(Required)
Have you applied for a scholarship with another non-profit?(Required)
HOW DID YOU HEAR ABOUT US?

ALREADY SPOKEN TO SWIM INSTRUCTOR?(Required)
PLEASE NOTE that instructor must know you are applying for scholarship.
If NO, please visit infantswim.com to ensure there is an ISR instructor in your area.
PLEASE EXPLAIN WHY YOU HAVE A FINANCIAL NEED TO REQUEST THIS SCHOLARSHIP.

*** UPLOAD REQUIRED DOCUMENTS BY USING THE "Drop files here or Select Files button" BELOW FOR EACH.

*** APPLICATIONS WILL NOT BE PROCESSED UNTIL ALL REQUIRED DOCUMENTS ARE SUBMITTED ***

A copy of the following documents MUST be provided to process the application. (For security measures please black out your SSN on all documents):

  • Driver’s License
  • Two current pay stubs (an additional two from your spouse/partner if applicable)
  • Your most recent tax return (e.g. complete 1040 form, federal tax return, NOT your W2 form)
Upload your files in .pdf, .doc, .docx or .jpg format
Drop files here or
Accepted file types: pdf, doc, docx, jpg, Max. file size: 25 MB, Max. files: 10.
    IF APPLICABLE PLEASE INCLUDE:
    • A “Did Not File” taxes form - PROOF REQUIRED
    • Social Security benefits statement
    • Disability benefit statement
    • Unemployment benefit statement
    • Child Support statement
    Upload your files in .pdf, .doc, .docx or .jpg format
    Drop files here or
    Accepted file types: pdf, doc, docx, jpg, Max. file size: 25 MB, Max. files: 10.
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      Copyright ©2022 Live Like Jake Foundation | Site by Brent Thomas.
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