BOLDER VALLEY HOCKEY FOUNDATION

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BOLDER VALLEY HOCKEY FOUNDATION Boulder Hockey Club Scholarship Committee 125 Superior Plaza Way, Superior, Colorado 80027 303-494-4777 tel 303-494-5180 fax www.boulderbison.com Parent Information First Name

Home Phone

Last Name

Cell Phone

Street Address City

ST

ZIP

Email Address Employer

Employer Phone

Player Information First Name

Birth Date

Last Name

Age

Street Address City

ST

ZIP

Hockey Participation (last season) Division & Team

BHC Seasons (not including the coming season)

Coach Name

Manager Name

Coach Phone

Manager Phone

Coach Email

Manager Email

I understand that I MUST submit the following information with this application in order to be considered for financial aid: Completed Scholarship Form Copy of player's most recent report card

Explanation of special personal circumstances Copy of most recent payroll/income check

Copy of most recent income tax return

I certify the information above is accurate and understand that the BVHF Scholarship Committee will verify all information. Deliberate misrepresentation will result in disqualification for financial assistance. I understand that each application is reviewed individually and scholarships are awarded based on funds avaiable, financial need, years in the BHC program, past scholarship funds received and special personal/family circumstances. Scholarships are awarded at the sole discretion of the BVHF Scholarship Committee. Submitting an appication does not guarantee financial aid. Further, I agree to procide any additional information requested by the BVHF Scholarship Committee and alert it of any changes in my/our finanacial condition.

Name of Parent or Legal Guardian: Signature of Parent of Legal Guardian:

Date: