Physically Challenged Athletes Scholarship Application

Legal Name
Last*
First*
Middle
Permanent Address
Number and Street*
City*
State*
Zip*
Permanent Phone*
Cell Phone*
Email Address*
If different from the above, please list your mailing address
Number and Street
City
State
Zip
Phone*
Date of Birth*
Sex*
Place of Birth*
Country of Citizenship
Possible Area(s) of Academic Concentration/Major*
Anticipated Graduation Date*
Do you hope to use this scholarship at*
- USC
- Other University
Scholarship Other University
Have you sent an admission application to the university of your choice?*
- Yes
- No
Have you been accepted?*
- Yes
- No
Have you applied for financial aid or other scholarships?*
- Yes
- No

Education Information Please list the schools that you have attended, beginning with the most recent. Include the dates of attendance, degree awarded and cumulative grade point average. Please list all high schools and colleges attended.
List*
School and Location Dates of Attendance Degree (if applicable) GPA
Scholastic and Academic Honors*
Extracurricular, Personal, and Volunteer Activities (Attach a resume if desired)
Resume File
Drop files here or

Accepted file types: jpg, gif, png, pdf, doc, docx, tiff, zip, txt.
Athletic experience and activities (include dates and level of participation in organized sports). Indicate sports participation before and after (if applicable) injury/illness and dates*
Extracurricular Activities and Organizations*
Hobbies and Interests*
Work Experience*
How did you find out about the Swim With Mike/PCASF Scholarship or who recommended that you apply?*

In what ways will you contribute to Swim With Mike and supporting activities?
As a Recipient*
As a Graduate or Alumni*
Financial Need

Your High School Counselor and/or the Financial Aid Office at your university can provide additional information regarding other college scholarships or financial aid that may be available to you. The FAFSA or Free Application for Student Aid can be found at: (www.fafsa.ed.gov). The CSS Financial Aid Profile can be found at: (www.collegeboard.com) Anticipated expenses for the academic year
Anticipated expenses for the academic year
- Tuition and Fees*
- Room and Board (On Campus)*
- Books*
- Total*
- Transportation*
- Personal*
- Total*
Financial resources available for the academic year
- Scholarships*
- Financial Aid or Grants*
- Loans*
- Total*
- Parents*
- Spouse*
- Savings*
- Earnings*
- Others*
- Total*
- Total Anticipated Amount Needed*

Documents to include with this application:
Personal Statement*
This personal statement helps us become acquainted with you as an individual. Please prepare an autobiographical statement with an emphasis on your athletic history and experience, plus your educational goals. Please type this statement and attach it to this application.
Drop files here or

Accepted file types: jpg, gif, png, pdf, doc, docx, tiff, zip, txt.
Letters of Recommendation*
Please attach three letters of recommendation. Two must be from administrators or faculty of the school, which you are currently attending or have recently attended. The third may be from anyone who is not related to you. Please submit the letters with this application. If letters will be sent separate from the application please include the names of those persons that will be sending recommendations on your behalf.
Drop files here or

Accepted file types: jpg, gif, png, pdf, doc, docx, tiff, zip, txt.
Verification of Disability*
Please include written documentation of your disability which includes the onset of accident or illness leading to the disability.
Drop files here or

Accepted file types: jpg, gif, png, pdf, doc, docx, tiff, zip, txt.
Unofficial Transcript of High School or Previous College Work*
Please include a copy of high school, or if applicable all college courses completed and grades.
Drop files here or

Accepted file types: jpg, gif, png, pdf, doc, docx, tiff, zip, txt.
Current Photograph*
Please include a current photograph of yourself which will be used on our website and in public relations materials. A head shot and a full body photo is best. Please do not include other persons in the photo. Digital photos may be sent to swimwithmike@gmail.com
Drop files here or

Accepted file types: jpg, gif, png, pdf, doc, docx, tiff, zip, txt.
Your signature below indicates that all of the information provided on this application is accurate. You agree that the information submitted on this application, including documentation of disability and health condition, may be released to the scholarship committee for determination of award.
- Signature*
- Date*
- Signature of Legal Guardian*
  (If applicant is under 18 years of age)
- Date*
Please sign the application by entering your full name below.*
Email
This field is for validation purposes and should be left unchanged.

Physically Challenged Athletes Scholarship Application

Deadline for Submission: May 1

The Mission of Swim With Mike is:

Swim With Mike is:

Swim With Mike’s Roots:

Scholarship Criteria:

The Scholarship Application Process:

Participation Expectations:

Step 1 of 5

Financial Need

Documents to include with this application:

Physically Challenged Athletes Scholarship Application

Deadline for Submission: May 1

The Mission of Swim With Mike is:

Swim With Mike is:

Swim With Mike’s Roots:

Scholarship Criteria:

The Scholarship Application Process:

Participation Expectations:

Step 1 of 5

Financial Need

Documents to include with this application:

Register