2. SWIM LESSON SCHOLARSHIPS

   Use this application to apply for the Swim Lesson Scholarship for group swimming lessons. (Scholarships will not be given for any private lessons.) Multiple applicants may be put on one application. Any missing information may result in the delay of application screening and/or denial of the application. Approval for a scholarship does not guarantee placement into the program. All approved applicants must register and pay the non-refundable fee of $15 per participant per swim lesson session to be guaranteed participation.

4. Swim Lesson Scholarship Criteria

   Use the chart below to see if you meet the income requirements. Qualified applicants will fall at 60% of Area Median Income or below. This chart uses HUD’s 2021 Income limits for Yolo County.  Use the gross income for the entire household. Provide verification of income that your family qualifies for the swim lesson scholarship. Submit copies of 2021 tax submission 1040 (not W2).

6. 
8. Parent First Name*
9. Parent Last Name*
11. Email Address*
12. Phone Number*
14. Address*
    PO Boxes and county road addresses will not be accepted
16. City*
17. State*
18. Zip Code*
20. Total Adults in Household*
21. Total Youth in Household*
25. Child #1 First Name*
26. Child #1 Last Name*
27. Child # 1 Birthday*
    Child # 1 Birthday
29. Child # 1 School
    If applicable
30. Child #1 Entering Grade
    -- Select One --Pre-school/No SchoolKindergarten1st2nd3rd4th5th6th7th8th
32. Swim Lesson Scholarship conditions

    Once a scholarship has been awarded, you must pay (the non-refundable) a reduced rate of $15 per 2-week session per child to be enrolled into the program. The maximum scholarships per family is 4. Maximum scholarships per child is 2.

    1. I acknowledge the conditions for Swim Lesson Scholarships
34. Add another child

    1. I would like to add another child to this application
38. Child # 2 First Name*
39. Child # 2 Last Name*
40. Child #2 Birthday*
    Child #2 Birthday
42. Child #2 School
    If applicable
43. Child #2 Entering Grade
    -- Select One --Pre-school/No SchoolKindergarten1st2nd3rd4th5th6th7th8th
45. Swim Lesson Scholarship conditions

    Once a scholarship has been awarded, you must pay (the non-refundable) reduced rate of $15 per 2-week session per child to be enrolled into the program. Maximum scholarships per family is 4. Maximum scholarships per child is 2.

    1. I acknowledge the conditions for Swim Lesson Scholarships
47. Add another child

    1. I would like to add another child to this application
51. Child #3 First Name*
52. Child #3 Last Name*
53. Child #3 Birthday*
    Child #3 Birthday
55. Child #3 School
    If applicable
56. Child #3 Entering Grade
    -- Select One --Pre-school/No SchoolKindergarten1st2nd3rd4th5th6th7th8th
58. Swim Lesson Scholarship conditions*

    Once a scholarship has been awarded, you must pay (the non-refundable) reduced rate of $15 per 2-week session per child to be enrolled into the program. Maximum scholarships per family is 4. Maximum scholarships per child is 2.

    1. I acknowledge the conditions for Swim Lesson Scholarships
60. Add another child

    1. I would like to add another child to the application
64. Child #4 First Name*
65. Child #4 Last Name*
66. Child #4 Birthday*
    Child #4 Birthday
68. Child #4 School
69. Child #4 Entering Grade
    -- Select One --Pre-school/No SchoolKindergarten1st2nd3rd4th5th6th7th8th
71. Swim Lesson Scholarship conditions*

    Once a scholarship has been awarded, you must pay (the non-refundable) reduced rate of $15 per 2-week session per child to be enrolled into the program. Maximum scholarships per family is 4. Maximum scholarships per child is 2.

    1. I acknowledge the conditions for Swim Lesson Scholarship
75. Swim Lesson Scholarship Agreement*

    I understand once approved, I must pay the applicable discounted fees associated for each participant to guarantee enrollment into the program(s).

    1. I agree.
77. Proof of residency in Woodland*
    Upload a copy of your of utility bill, PG&E bill, or rental agreement to verify proof of residency in the City of Woodland.
79. Proof of Income Qualification*
    Upload a copy of your income qualification for the Swim Lesson Scholarship. .
81. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
83. Electronic Signature
84. Date
    Date
Leave This Blank:


86. Submit

* indicates a required field