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Jump Start Application Form
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Jump Start Application Form
Image
Section 1: Application Information
Name:
Birth date:
Gender:
Male
Female
Address
Address:
City/Town:
Province:
Postal code:
Telephone:
Email:
Section 2: Request for Funding
I would like to request funding for:
Sport or activity
Registration fees
Other
Please provide details
Organization name:
Fee amount:
$
Organization contact:
Telephone:
Address
Address:
City/Town:
Postal code:
Please indicate sport or recreation activity start date:
Please indicate length of sport or recreation activity:
Section 3: Endorsement
1) Parent / Guardian / Counsellor
Name:
Please indicate relationship to applicant:
Address
Address:
City/Town:
Province:
Postal code:
Telephone:
Email:
I certify my submission of the above child/youth and verify that all the information given is correct and can be substantiated
I certify my submission of the above child/youth and verify that all the information given is correct and can be substantiated.
Signature of adult:
Sign above
Date:
2) Community Leader / Professional
Please attach a letter from a Community Leader indicating relationship to applicant and a verification of the applicant’s economic barrier to participate in the requested activity or program. The Community Leader should be in a position to identify and assess the economic barriers of the applicant.
Add an attachment
Maximum 3 files.
10 MB limit.
Allowed types: pdf, doc, docx.
Organization name:
Position:
Address
Address:
City/Town:
Province:
Postal code:
Telephone:
Email:
Canadian Tire JumpStart and its members will respect the confidentiality of all applicants
For Office Use Only
Application received:
Application complete:
Accepted:
Reason:
First-time funding:
Amount ($):
Allocation period:
Cheque #:
Cheque date: