AFFORDABLE RATE PROGRAM APPLICATION Head of Household * First Name Last Name Phone (###) ### #### Email * Address Address 1 Address 2 City State/Province Zip/Postal Code Country How Many Family Members In Your Household? Total number of people living in your household. Family's Annual Income * Put the combined amount of your family's annual income based on your most recent tax filing. $ Income Level * Income level based on the number of people in your household and your total annual based on the FY 2025 Income Limits System chart at the top of this page. Low Income- $111,700-$210,650 Very Low Income-$70,350-$132,600 Extremely Low Income-$42,200-$79,550 Why Are You Applying * Briefly explain why you are applying for the Affordable Rate Program and how this program will help you and your family. Who Will This Benefit * Explain whom will be taking tennis lessons through the Affordable Rate Program. Acceptance Agreement * By proceeding, you acknowledge and agree to the following: I hereby authorize GripSpin Tennis to request and review a copy of my most recent federal tax return for the sole purpose of verifying my stated income. I understand this information will be kept confidential and used exclusively for determining your eligibility for the Affordable Rate Program. I further agree to provide GripSpin Tennis with the necessary documentation and information to facilitate this verification process, which may include, but is not limited to, my Social Security Number (SSN) or Taxpayer Identification Number (TIN) and a signed consent form for the release of tax information. I understand that my refusal to provide this information or any discrepancy found during the income verification process may result in an immediate cancellation of service in the program and may result in your information being turn over to the proper authorities. This agreement is valid for the duration of my application/participation in Affordable Rate Program with GripSpin Tennis. I agree to the terms and conditions outlined above. Thank you!
