Special Achievement Award Claim Form

Questions contact:
awards@allclasswrestling.com


ALL FIELDS ARE REQUIRED.
INCOMPLETE INFORMATION WILL DELAY THE DISBURSEMENT OF YOUR SPECIAL ACHIEVEMENT AWARD.
 
  STUDENT INFORMATION:

First Name
 
   
  Middle Initial  
   
  Last Name  
   
  Current Street Address
(Include apt.#)
 
   
  City  
   
  State  
   
  Zip Code  
   
  Phone #  
 
xxx-xxx-xxxx
 
  Email Address  
   
  PARENT/GUARDIAN INFORMATION
(fill in one):


First Name
 
   
  Last Name  
   
  Current Street Address
(Include apt.#)
 
   
  City  
   
  State  
   
  Zip Code  
   
  Phone #  
 
xxx-xxx-xxxx
 
  Email Address  
   
  SCHOOL OR PROGRAM TO RECEIVE AWARD FUNDS FOR YOUR BENEFIT:

School or Program Name
 
   
  Street Address  
   
  City  
   
  State  
   
  Zip Code  
   
  Main Phone  
 
xxx-xxx-xxxx
 
  Student ID#  
   
  Financial Dept. Contact  
   
  Financial Dept. Phone  
 
xxx-xxx-xxxx
 
  Email Address  
   
  If your school or program does not assign a unique student identification number, please provide your social security number. Failure to do so will delay the disbursement of your special achievement award.  
  THE INFORMATION YOU PROVIDE IN THIS CLAIM FORM WILL BE USED BY ADF STRICTLY FOR THE PURPOSES OF PROCESSING YOUR SPECIAL ACHIEVEMENT AWARD AND DISPERSING FUNDS ON YOUR BEHALF TO THE SCHOOL OR PROGRAM OF YOUR CHOICE. YOUR INFORMATION WILL BE KEPT PRIVATE AND CONFIDENTIAL AND IN NO WAY WILL BE SHARED, EITHER IN PART OR IN WHOLE, WITH ANY OUTSIDE PARTIES.