Scholarship - Sail CT Access

Scholarship Application

Please complete this form to apply for a scholarship with Sail Connecticut Access

Applicant Name(Required)

First Last

Email(Required)

Phone(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Emergency Contact Information

Emergency Contact Name(Required)

First Last

Emergency Contact Phone(Required)

Emergency Contact Email

Emergency Contact Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Parent or Guardian Permission — Required if applicant is under 18

Parent or Guardian Name

First Last

Parent or Guardian Phone

Type your full name as your signature

By typing your name above, you are providing your electronic signature granting permission for the named minor to participate in SCTA volunteer activities and acknowledging the associated risks.

Date

Parent/Guardian Acknowledgment

Yes

I am the parent or legal guardian of the volunteer named above and I give permission for them to volunteer with SCTA. I have read and agree to the SCTA Liability Waiver and Privacy Policy

Please describe your hardship or why you need this scholarship(Required)

Is there an amount you think you can pay?

All SCTA Participants Must Agree to the Terms of Service

Yes

I have read and agree to the SCTA Liability Waiver and Privacy Policy