Step 2: Complete Recommendation Form

The purpose of this program is to help children and adults reach their health, fitness and athletic goals by subsidizing the fees associated with their chosen sport and other related activities.

Stipends will be paid directly to the organization hosting the athletic activity. This stipend is awarded with expectation that your child will remain enrolled in this activity for at least the duration of the season or time specified in your application. Barring extenuating circumstances, we strongly discourage withdrawing your child from the activity in which (s)he is participating. Should you choose to withdraw your child and you do receive a full or partial refund of the registration fees and or other expenses that were covered by Health Quest Solutions, Inc stipend, we request that those funds be returned to Health Quest Solutions, Inc immediately so that they can be used to subsidize the athletic and fitness goals of another child in need of reaching specific athletic or fitness goals.

Thank you for your commitment to keeping our children healthy and fit!

  This form must be filled out by a teacher, clergyman (women), sports or activity coach, counselor, school bus driver, or principal.   

All fields required unless otherwise stated

Thank you for taking time to complete the recommendation form for He/She is applying for an activity/ sport stipend. In order to combat childhood obesity and physical inactivity we help parents pay a portion of their child’s recreational activity fees. We appreciate your interest in the health and well-being of this candidate. Your recommendation is important and greatly appreciated.

On a scale of 1-5, (5 being the highest, 1 being the lowest) please rank your thoughts on the above child.

1. Child is concerned about doing well in school.
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2. He/ she works well with others.
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3. Child is respectful of authority.
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4. He/ she is kind to other children and others.
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5. Child is able to follow instructions when given.
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6. Child is polite and exhibits good manners.
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7. Please briefly explain why you believe this child is deserving of the Health Quest Solutions, Inc. sport/ activity stipend.

8. Please give a few of the child’s strengths and weakness.

9. How do believe the sport/ activity stipend will benefit the parent or parents of the child.

Recommender's Information

First Name

Middle Name (optional)

Last Name

Address

City

State

Zipcode

Email Address

Phone Number

Cell (optional)

Occupation/Title

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