EMSSC Memorial Scholarship APPLICATION - LeagueAthletics.com
EMSSC Memorial Scholarship APPLICATION We ask that any parent/guardian requesting Scholarship funding complete the application below and include ONE the following: Copy of the first two pages of parent/guardian’s most recent tax return to the address listed below Or Copy of any kind of State assistance MUST have child's name on it and be current. LIMIT ONE GRANT PER FAMILY All applications must be submitted by July 30. Late applications or missing documentation could result in a denied request. Player's Name______________________________________ Players age_____ Birth date (including the year) __________
Male or Female
Address _____________________________________City__________ Zip________ Father/Guardian Name_____________________Mother’s Name____________________ Address _____________________________________City__________ Zip________ Home phone:______________ Cell Phone______________ Email_________________________ Applying for assistance with: Travel Soccer:______ or REC Soccer ________
VOLUNTEER AGREEMENT I UNDERSTAND and agree that volunteering is part of the obligation when I receive this scholarship. It's in addition to my team volunteerism. If my child doesn't complete the WHOLE season or I do NOT fulfill my obligation to volunteer a minimum of 4 hours in the Fall and 4 hours in the Spring. I will be asked to repay all fees waived and pay for all the equipment provided by the Scholarship funds. Please sign that you understand the agreement above: _________________________________________________________
Describe why you as the parent/guardian are requesting grant assistance. Use the space provided below and attach an additional sheet if necessary. ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________
________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Current Employer: Father/Guardian __________________________________________ Address________________________________ City____________________ Current Employer: Mother/Guardian _________________________________________ Address________________________________ City____________________ Submit form to: EMSSC Soccer Scholarships P.O. Box 455 East Moline IL, 61244
============================================================================== EMSSC Scholarship Committee Section Decision: _____Approved _____Denied Applicant notified by: ______________________date__________
Male or Female
Address _____________________________________City__________ Zip________ Father/Guardian Name_____________________Mother’s Name____________________ Address _____________________________________City__________ Zip________ Home phone:______________ Cell Phone______________ Email_________________________ Applying for assistance with: Travel Soccer:______ or REC Soccer ________
VOLUNTEER AGREEMENT I UNDERSTAND and agree that volunteering is part of the obligation when I receive this scholarship. It's in addition to my team volunteerism. If my child doesn't complete the WHOLE season or I do NOT fulfill my obligation to volunteer a minimum of 4 hours in the Fall and 4 hours in the Spring. I will be asked to repay all fees waived and pay for all the equipment provided by the Scholarship funds. Please sign that you understand the agreement above: _________________________________________________________
Describe why you as the parent/guardian are requesting grant assistance. Use the space provided below and attach an additional sheet if necessary. ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________
________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Current Employer: Father/Guardian __________________________________________ Address________________________________ City____________________ Current Employer: Mother/Guardian _________________________________________ Address________________________________ City____________________ Submit form to: EMSSC Soccer Scholarships P.O. Box 455 East Moline IL, 61244
============================================================================== EMSSC Scholarship Committee Section Decision: _____Approved _____Denied Applicant notified by: ______________________date__________
