Scholarship Application - Dive Pirates Foundation

Scholarship Application Form 2024

Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Email
Application
Please complete the following in as much detail as you can, so we can carefully consider your application:
I am applying for
Check all that apply
- Bert and Ann Shearer Scholarship
- Brandes Family Scholarship
- Suzy Fago Memorial Scholarship
When was the last time you went diving?
What barriers keep you from joining your chapter's or other Dive Pirate Foundation trips, or exploring on your own? Fixed Income? Financial or family obligations?
What would receiving this scholarship mean to you?
If you receive this scholarship, how will you help pay it forward for the next recipient?
Tell us what impact the initial trip had on you personally.
Tell us what you have been doing, what’s going on in your life.
Recommendation letter from an instructor, Dive Pirates member, or from someone in the diving community.*
Drop files here or

Accepted file types: pdf, Max. file size: 1 MB.
Please upload your completed medical form and physicians sign off.*
Drop files here or

Accepted file types: pdf, Max. file size: 1 MB.
Please upload current photo(s)*
Drop files here or

Accepted file types: jpg, jpeg, Max. file size: 1 MB.
I agree to*
- be responsible for having a current passport. If my passport is out of date at the time of scholarship acceptance (January 15, 2023) recipient must apply for and receive a new passport before airfare is secured (must have passport before March 1, 2024). If I fail this requirement I understand the next viable candidate will be chosen.
- be responsible for any refresher course needed.
- be responsible for obtaining and must show proof of Dive Insurance.
- be responsible for inspecting my scuba equipment. If any equipment needs servicing or replacing I will contact DPF by March 1, 2024 and accept any donated equipment options available. (Replacement equipment will be on a case-by-case basis).
Applications will not be considered unless all elements of the application are included. All elements of the application must be provided by end of the day on December 31, 2023.
All applicants will be notified of results by January 15, 2024.
Scholarship winner will be included in the 2024 Dive Pirates Ball program and announced during the event.
Your information will only be shared with the scholarship committee and will be kept confidential.

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