Application for Financial Assistance
Application for Financial Assistance One of the many goals of the PDA Florida is to ensure that any child with the desire, commitment, and ability to play soccer be afforded the opportunity regardless of financial ability. As funds are limited, most Financial Assistance awards are “partial financial aid” and families are expected to pay for a portion of the player’s fees. Financial aid is based on assessment of need. Before Financial Assistance will be awarded, the parents or guardians of the prospective Financial Assistance recipient must complete this Financial Assistance Application. These decisions will be made on a case by case basis. Each player receiving financial aid must meet and adhere to all guidelines and demonstrate dedication through consistent attendance at program training sessions and events. It is also the responsibility of each family receiving financial aid to reciprocate through active participation in PDA Florida events. Failure to adhere to these guidelines may result in the forfeiture of any financial assistance awarded. Please complete this form in its entirety, place in a sealed envelope, and send to the club mailing address at the bottom of this document or scan and email to: [email protected]. Information on this application will remain confidential. In order to be considered for financial aid, proof of need must be demonstrated. PDA Florida will review your application and will contact you with a decision. Please only submit one application per family. Player Name _____________________________________ Player Name _____________________________________ Player Name _____________________________________ Player Name _____________________________________ Mother/Guardian Name ________________________________________________________________________ Employer __________________________________________________ Work Phone ____________________ Father/Guardian Name ________________________________________________________________________ Employer ___________________________________________________ Work Phone ___________________ Home Address _______________________________________________ Home Phone __________________ Cell Phone _____________________________ Email ______________________________________________
Number & Ages of Dependent Children in Household (other than those listed above): _________________________________________________________________________________________ * Annual Household Income _________________________________________________________________________________________ Financial Aid Requested: Cost of Program $______________________________ Amount You Can Pay $_________________________ In order to receive financial assistance, you must agree to the following. Please initial on the line that you understand and have read the commitment: ______ I agree to adhere to all guidelines and demonstrate dedication through consistent attendance at program training sessions and events. I also agree to reciprocate through active participation in the PDA Florida activities and events. ______ I have attached proof of need (i.e. pay stubs, W-2, 1040 Form, eligibility letter for free/reduced school lunch, or letter explaining extenuating circumstances and/or hardships). ADDITIONAL INFORMATION: Please provide any details about your particular situation that you feel would be important in determining your need for financial assistance. Use additional paper if necessary and attach to this form. PDA Florida PO Box 352493 Palm Coast, FL 32137 Email: [email protected]
Number & Ages of Dependent Children in Household (other than those listed above): _________________________________________________________________________________________ * Annual Household Income _________________________________________________________________________________________ Financial Aid Requested: Cost of Program $______________________________ Amount You Can Pay $_________________________ In order to receive financial assistance, you must agree to the following. Please initial on the line that you understand and have read the commitment: ______ I agree to adhere to all guidelines and demonstrate dedication through consistent attendance at program training sessions and events. I also agree to reciprocate through active participation in the PDA Florida activities and events. ______ I have attached proof of need (i.e. pay stubs, W-2, 1040 Form, eligibility letter for free/reduced school lunch, or letter explaining extenuating circumstances and/or hardships). ADDITIONAL INFORMATION: Please provide any details about your particular situation that you feel would be important in determining your need for financial assistance. Use additional paper if necessary and attach to this form. PDA Florida PO Box 352493 Palm Coast, FL 32137 Email: [email protected]
