Financial Assistance Application - LeagueAthletics.com
PETALUMA YOUTH LACROSSE (PYL) 925 Lakeville Street #166 Petaluma CA 94952
Financial Assistance Application Deadline: November 30, 2017 Player Information: Name : ______________________________________ Date of Birth: _______________________ No. of years in Club: ___________________________ Age Division: _______________________ Parent Information: Name: __________________________________________ Email: _________________________ Address: ________________________________________ Home Phone: ___________________ City: _______________________ Zip _________________ Cell Phone: _____________________ Signature:________________________________________ Date:____________________________
Required Information: 1.
Amount of scholarship requested: _____________________
2.
Explanation of why financial assistance is required this year such as a current event or situation necessitating the request (e.g. job loss, foreclosure etc) or low income (e.g. participation in School reduced lunch program). If additional space is required, please attach to this form.
_____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________
1
10/1/2017
3.
Annual Gross Household Income. NOTE: Verification of Income in the form of a copy of the front page of last year’s Personal Federal Tax Return will need to be provided (may eliminate personal information for example social security numbers).
______________________________________________ 4.
Verification of Grades: Include a copy of player’s most recent report card. (attach to this form)
5.
Volunteer Commitment: In addition to the normal five (5) hours of volunteer service that is required. PYL now requires scholarship recipient families to also fulfill a total of ten (10) hour of volunteer service, which are required to be completed by working the Final Horn (date TBD) and Fireworks Booth (June 30 th-July 4th) events. These programs directly support scholarships and each family who are scholarship recipients will be required to support our biggest and most labor-intensive fundraisers. Signature of this application is considered a formal commitment to perform the volunteer work as coordinated by the team parent, coach, volunteer coordinator, and treasurer. Please indicate any known conflicts below. Additionally, please provide any special skills and areas of interest. _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ 6.
Name of prior coach for contact for a recommendation, or from other PYL member:
____________________________________________________________________________ 7.
Has player previously received Financial Assistance from PYL? Yes __ No __ What season(s): 2017 _____ 2016 ______ 2015 ______ 2014 ________
Financial Assistance Process Information 1.
2. 3. 4. 5.
6. 7. 8.
All Financial Assistance Applications must be completed and postmarked or emailed by November 30, 2017. Completed applications may be mailed to: PYL Financial Assistance Coordinator, 911
Lakeville Street #166 Petaluma CA 94952 or scanned and sent via email to the Club Treasurer at: [email protected]
All Financial Assistance Applications must include all the required information. Omitted materials could be a cause for disqualification. Additional information may be required to support request for assistance. Preference is given to applicants with a current compelling need for assistance. GPA’s below 2.00 may be disqualified for consideration unless there are diagnosed learning disabilities or other relevant educational issues. Commitment of players and/or parent to volunteering is important to the success of the club. The level of commitment to volunteering is weighted significantly in the assistance approval process. Please note, that effective October 1, 2017 PYL will require an additional ten (10) hours of volunteer service hours to be completed during the Final Horn and the annual Fireworks Booth. Priority consideration may be given to applicants who are returning lacrosse players and to those applicants whose primary sport is lacrosse. No applicant will be considered if there is an outstanding balance for prior year(s) fees. If partial scholarship is approved, applicant must make arrangements to make payments for the remaining balance due for the registration fee by due date. All fees must be paid prior to the player taking the field for practices or games.
2
10/1/2017
Financial Assistance Application Deadline: November 30, 2017 Player Information: Name : ______________________________________ Date of Birth: _______________________ No. of years in Club: ___________________________ Age Division: _______________________ Parent Information: Name: __________________________________________ Email: _________________________ Address: ________________________________________ Home Phone: ___________________ City: _______________________ Zip _________________ Cell Phone: _____________________ Signature:________________________________________ Date:____________________________
Required Information: 1.
Amount of scholarship requested: _____________________
2.
Explanation of why financial assistance is required this year such as a current event or situation necessitating the request (e.g. job loss, foreclosure etc) or low income (e.g. participation in School reduced lunch program). If additional space is required, please attach to this form.
_____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________
1
10/1/2017
3.
Annual Gross Household Income. NOTE: Verification of Income in the form of a copy of the front page of last year’s Personal Federal Tax Return will need to be provided (may eliminate personal information for example social security numbers).
______________________________________________ 4.
Verification of Grades: Include a copy of player’s most recent report card. (attach to this form)
5.
Volunteer Commitment: In addition to the normal five (5) hours of volunteer service that is required. PYL now requires scholarship recipient families to also fulfill a total of ten (10) hour of volunteer service, which are required to be completed by working the Final Horn (date TBD) and Fireworks Booth (June 30 th-July 4th) events. These programs directly support scholarships and each family who are scholarship recipients will be required to support our biggest and most labor-intensive fundraisers. Signature of this application is considered a formal commitment to perform the volunteer work as coordinated by the team parent, coach, volunteer coordinator, and treasurer. Please indicate any known conflicts below. Additionally, please provide any special skills and areas of interest. _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ 6.
Name of prior coach for contact for a recommendation, or from other PYL member:
____________________________________________________________________________ 7.
Has player previously received Financial Assistance from PYL? Yes __ No __ What season(s): 2017 _____ 2016 ______ 2015 ______ 2014 ________
Financial Assistance Process Information 1.
2. 3. 4. 5.
6. 7. 8.
All Financial Assistance Applications must be completed and postmarked or emailed by November 30, 2017. Completed applications may be mailed to: PYL Financial Assistance Coordinator, 911
Lakeville Street #166 Petaluma CA 94952 or scanned and sent via email to the Club Treasurer at: [email protected]
All Financial Assistance Applications must include all the required information. Omitted materials could be a cause for disqualification. Additional information may be required to support request for assistance. Preference is given to applicants with a current compelling need for assistance. GPA’s below 2.00 may be disqualified for consideration unless there are diagnosed learning disabilities or other relevant educational issues. Commitment of players and/or parent to volunteering is important to the success of the club. The level of commitment to volunteering is weighted significantly in the assistance approval process. Please note, that effective October 1, 2017 PYL will require an additional ten (10) hours of volunteer service hours to be completed during the Final Horn and the annual Fireworks Booth. Priority consideration may be given to applicants who are returning lacrosse players and to those applicants whose primary sport is lacrosse. No applicant will be considered if there is an outstanding balance for prior year(s) fees. If partial scholarship is approved, applicant must make arrangements to make payments for the remaining balance due for the registration fee by due date. All fees must be paid prior to the player taking the field for practices or games.
2
10/1/2017
