Umoja Outreach – Financial Aid – Umoja Outreach Foundation

Name*
First Last
Phone*
Email*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Occupation*

If student, please simply write student
Employer*
Marital Status*
No of Children wishing to attend:*
Spouse Information
Name*
First Last
Phone*
Email*
Occupation*

If student, please simply write student
Employer*
Children Information
Children*
First Name Last Name Age
Financial Standing
Total Annual Income:*
Total Annual Expenses*
Total Amount of Savings*
What is the financial assistance for?
- Umoja Games
- Umoja Academy
- Other
What do you need assistance on?
- Registration fees
- Team kits
- Hotel accommodation
- Other
Please explain your need for financial assistance and any other information that would help the organization understand your circumstances*
References
Please fill out two references for your family and their corresponding phone numbers.
Reference #1 Name*
First Last
Reference #1 Phone*
Reference #2 Name*
First Last
Reference #2 Phone*
Additional Information and Signature
Why would you like yourself and/or your child(ren) to participate in the Umoja Games?*
I hereby confirm that the above statements are true and I have not misrepresented my situation in requesting financial aid from Umoja Outreach Foundation.*
Please sign and date below if you agree with the above statement. Thank you.
Name Date

Spouse Information

First Name	Last Name	Age