Student Athlete Consortium Assistance Application

Note: Assistance is contingent upon meeting the prerequisites and available funds. Submission of application does not guarantee assistance. Community and organization donations are essential to funding applications.

- Student Athlete plays a sport in a competitive league

- Student Athlete is currently active in a competitive sport

- Student Athlete has a GPA of 3.0 or greater

- Student Athlete has 10 or more community outreach hours

Age of Student Athlete

School of Attendance

Current Grade Point Average

Volunteer hours for the current year

TYPE OF ASSISTANCE

How has sports impacted your student athletes mental health? Select one or many.

How has sports impacted your student athletes physical health? Select one or many.

STUDENT - RACE

Optional Demographic Information

STUDENT - ETHNICITY

Optional Demographic Information

Phone

Payment will be made payable or directly to the sport organization.

Provide organizations account name for either one of these methods: Check, Venmo, PayPal.

PAYMENT METHOD*

Provide organizations preffered payment method.

HOUSEHOLD SIZE

Student Athlete's demographic information. Optional.

HOUSEHOLD INCOME

Parents/Guardians demographic information. Optional.

HOUSING

Optional Demographic Information

PARENT/GUARDIAN MARITAL STATUS

Optional Demographic Information

LANGUAGE

Optional Demographic Information

STUDENT LIVES with

Optional Demographic Information

It is the request of the Student Athlete Consortium that the demographic information be proved as the data will be consolidated and deidentified. The deidentified data will be utilized in the application of grants for funding. Providing demographic information is confidential and optional. All information will be deidentified. Deidentified information is the process used to prevent someone's personal identity from being revealed.



The information provided is true and accurate.


Electronic Signature

DISCLOSURE*

Our ability to provide support to student athletes is made possible through donations from individuals and community organizations.


Please be aware that submitting an application does not guarantee that assistance will be available. Funding is dependent on the availability of resources at the time your application is received. If funds are not available, we will be unable to fulfill your request.


By submitting this application, you acknowledge and agree that there is a possibility that assistance may not be provided due to funding limitations. If you do not agree with these terms, please refrain from submitting an application.