Notice and Application for Member Scholarship Program

Fontana Aquatics Club

Notice and Application for Member Scholarship Program

The Fontana Aquatics Club (FAC) provides a limited number of scholarships to our members to help economically disadvantaged families with some of the cost of membership dues. These scholarships are on a first come, first available, rolling basis until all scholarship funds are designated for the swim season. The financial aid decisions are based on the availability of funds and FAC rules and policies. We are required by law to consider all your resources when determining your eligibility. If your household qualifies for a discount on your energy bill under the electric or gas CARE or telecommunications ULTS programs, you may qualify for a scholarship.

INCOME REQUIREMENTS

Number of Persons Total Combined Income Living in my Home from ALL Sources:

1 or 2 $31,300

3 $36,800

4 $44,400

5 $52,000

6 $59,600

For each additional person, add $7,600

WHAT ARE THE QUALIFICATIONS?

·  Must be a resident within the Fontana City Limits

·  Swimmer(s) is in good standing with FAC

·  I am currently qualified for the energy bill (electric, gas CARE, water or telecommunications ULTS) programs

·  Presentation of a utility bill (electric, gas, or telephone showing participation in their rate discount program) is acceptable verification of household income

·  Enrollment in the school reduced lunch program

·  My total annual income cannot exceed the amount shown on the above chart. Total income means the total combined gross household income of all persons living in my home

·  I must renew my application every year or sooner, if requested

·  I must notify the FAC Board within 30 days if I become ineligible for any of the required programs

I understand that for CARE "gross household income" means all money and non-cash benefits, available for living expenses, from all sources, both taxable and non-taxable, before deductions, for all people who live in my home. This includes, but is not limited to: Wages, salaries and commissions; child/spousal support; interest, dividends, or withdrawals from savings accounts, stocks and bonds, or retirement accounts such as IRA and 401K accounts; stocks; bonds; business or rental income; support from family or friends; cash gifts; loans; lottery winnings; tax refunds and money from insurance policies or legal settlements; Social Security; retirement, veterans, disability, or unemployment benefits and workers' compensation; AFDC; SSI; SSP; cash public assistance; food stamps and free housing or utilities; and school grants, loans, scholarships, or other aid. Proof of income acceptable to FAC will be provided when applying for or renewing application.

FAC Members Scholarship Application

APPLICATION INFORMATION (please type or print):

Applicant's Name ______

Child(ren)/Swimmer Participant Name ______

Address______

Telephone No. (Home) ______(work) ______

Number of People Living in Household ______

Gross Annual Income of Household ______

Coach’s approval______

Declaration and Self-Certification Statement:

By signing below, I certify under penalty of perjury that this information is true and correct under the laws of the State of California. I agree to provide two proofs of income if asked. I agree to inform

Fontana Aquatics Club if I no longer qualify to receive the discount. I know that if I receive a discount without qualifying for it, I may be required to pay back the discount I received. FAC reserves the right to revoke your scholarship.

Applicant's Signature ______Date Signed ______

Please hand-deliver your completed application to an FAC Board Member

______

FOR FONTANA AQUATICS CLUB USE ONLY

Date Received: Documentation Provided:

Date Verified: Verified by:

Date Entered In System: