Required Field *

Note: Uniform costs are not eligible for scholarship.

*Type      Recreational  Middle School          Scholarship (Deadline 08/06/13 2:00 PM)
                Competitive Scholarship  *Season:Fall  (Deadline is 07/2/13)Spring 

Please provide the following contact information:

*Player Name
*Parents:	Mother:  Father:
*Home Phone
*E-mail
Cell Phones	Mom Cell:Dad Cell:
Home Phone

Player information:

MS School Name	*Age Division: Select U-3 U-4 U-5 U-6 U-7 U-8 U-9 U-10 U-11 U-12 Middle School U-13 U-14 U-15 U-16 U-17 U-18 *Gender:  Boy Girl
Coach
Coach Phone
Coach Cell:
Coach E-mail

*Explain the circumstances of your financial need. Please be brief. Do not use colon or semi colon:

*Total Annual Household income: *Total Dependants: Employer's Phone Number:

*Amount Requested $ *Amount Paid so far $(Must be at lease half of regular registration fee and include uniform payment if uniform is ordered or request will not be considered.)

(Fund Guidelines limit the Amount Requested to one half of the registration fee only and does not include the uniform cost.)

Requests received after the Deadline will not be considered.

All Scholarship recipients are required to put in some volunteer time and meet certain attendance requirements:

• Volunteer hours required range from 1-4 hours (per family per scholarship) depending on level of scholarship
• Attendance: Competitive players must b at 90% of practices and 100% of games with the exception of illness and/or injury. Recreational players must be at 80% of practices and 100% of games.

By entering my name below and submitting this form, both parent and player agree to the volunteer and attendance requirements for receiving a scholarship stated above. Parents affirm that all information provided is true and correct to the best of their knowledge.

Parent Name: Player Name: