FINANCIAL ASSISTANCE APPLICATION
Howard County Youth Program BASKETBALL FINANCIAL ASSISTANC APPLICATION
FINANCIAL ASSISTANCE APPLICATION – General Information The Howard County Youth Program (HCYP) provides financial assistance in the form of reduced registration fee to help eligible youth participate in the HCYP basketball program. This program provides assistance to youths from low-income families in Howard County that are not currently being served by existing scholarship or fee waiver programs. To be eligible for assistance, each child must: Qualify for, or be currently receiving assistance from one of the following programs listed below:
Meet each of the criteria below:
AND
Free or Reduced School Lunch
Temporary Assistance for Needy Families
Foster Care
Medicaid/Social Security Income
Food Stamps
Referred by HCPSS counselor or case worker
Be enrolled in school (Kindergarten through 12th grade)
Commit to attend a minimum of 50% of scheduled practices and games
Not be currently served by existing scholarships or fee waiver program
HCYP recognizes that some children may benefit from team sports that do not meet the eligibility guidelines stated above. Contact the HCYP Director of Basketball ([email protected]) for more information. To Apply: Parents/Legal Guardians must complete the application and submit it as outlined below: 1. To apply, complete the application and ensure that the application has been signed by a parent or legal guardian. Attach official documents signifying the child is receiving aid. If such documents are not available, a school administrator, social worker, or case worker must sign the form to verify eligibility. 2. Submit applications by the deadline below via email to [email protected] or regular mail to: FINANCIAL ASSISTANCE APPLICATION HCYP Basketball P.O. Box 1662 Ellicott City, MD 21043 If you have any questions or concerns, please contact the Director of HCYP Basketball, Mr. BJ Borden @ [email protected]
1
Howard County Youth Program BASKETBALL FINANCIAL ASSISTANC APPLICATION
FINANCIAL ASSISTANCE APPLICATION – Important Information Funding is extremely limited therefore reduced rates are awarded on a first come first served basis. Assistance is also subject to space availability for each sports age groups. In order to provide a fair distribution of funds, some children in a family may not be granted assistance even if others are so that we may serve as many families as possible. The signature on the financial assistance application is an agreement that the parent/guardian/youth athlete will pay the required reduced amount to the program or request a refund before the program begins. A complete registration form is required prior to final awarding of the scholarship. The application also must be completed for consideration. All required information lines must be filled in completely and accurately with appropriate approval signature. SUBMIT COMPLETED APPLICATIONS TO FINANCIAL ASSISTANCE APPLICATION HCYP Basketball P.O. Box 1662 Ellicott City, MD 21043 HCYP Basketball must be paid in full at the reduced rate before the start date of the program or the youth athlete will not be able to participate. Fee Waiver: The youth athlete will have a substantial portion of the registration fee for HCYP Basketball waived. Typically, the youth athlete will pay 20% to 50% of the regular registration fee for HCYP Basketball.
2
Howard County Youth Program BASKETBALL FINANCIAL ASSISTANC APPLICATION
FINANCIAL ASSISTANCE APPLICATION – Completion Form Parents/Guardians: Complete this entire application with appropriate signatures and submit to the HCYP Basketball Director. If you are seeking assistance for one than one child, you must fill out a Financial Assistance Application for each child. Child’s Name: Parent/Guardian’s Name:
Gender:
Address:
Date of Birth:
Daytime Phone:
Howard County School Attending:
Cell/Evening Phone:
Current Grade:
Email address:
CONSENT TO RELEASE INFORMATION
I understand that personal and sensitive information may be needed to verify eligibility for HCYP Basketball financial assistance. Therefore, in order for HCYP Basketball to access information and coordinate services with other agencies, I agree that agencies may share information. I also certify that the information supplied is true and correct and that HCYP staff have my permission to verify the information on this application. I understand that my child’s participation in this program requires a commitment to attend a minimum of 50% of the scheduled practices and games.
REQUEST FOR A FEE WAIVER My child is currently enrolled in a public assistance program such as Free and Reduced Lunch, ADC, Foster Care, or Medicaid . I request a fee waiver for the HCYP Basketball Program and give my permission for the Dep artment of Family Services or the Howard County Public School System to release information verifying eligibility. I further understand that I must submit proof that I am receiving services.
Signature of Parent/Guardian:
Date:
A non-returnable copy of the official documentation signifying that the child is receiving aid must be attached. If documentation is not available, the following section must be completed and signed by a HCPSS school counselor or administrator, case worker or other official. I verify this applicant meets the HCYP Basketball financial assistance guidelines as specified above.
Name of Official:
Organization:
Address of Organization/School:
Position:
Signature and Date:
Phone:
SUBMIT COMPLETED APPLICATIONS TO FINANCIAL ASSISTANCE APPLICATION HCYP Basketball P.O. Box 1662 Ellicott City, MD 21043 3
FINANCIAL ASSISTANCE APPLICATION – General Information The Howard County Youth Program (HCYP) provides financial assistance in the form of reduced registration fee to help eligible youth participate in the HCYP basketball program. This program provides assistance to youths from low-income families in Howard County that are not currently being served by existing scholarship or fee waiver programs. To be eligible for assistance, each child must: Qualify for, or be currently receiving assistance from one of the following programs listed below:
Meet each of the criteria below:
AND
Free or Reduced School Lunch
Temporary Assistance for Needy Families
Foster Care
Medicaid/Social Security Income
Food Stamps
Referred by HCPSS counselor or case worker
Be enrolled in school (Kindergarten through 12th grade)
Commit to attend a minimum of 50% of scheduled practices and games
Not be currently served by existing scholarships or fee waiver program
HCYP recognizes that some children may benefit from team sports that do not meet the eligibility guidelines stated above. Contact the HCYP Director of Basketball ([email protected]) for more information. To Apply: Parents/Legal Guardians must complete the application and submit it as outlined below: 1. To apply, complete the application and ensure that the application has been signed by a parent or legal guardian. Attach official documents signifying the child is receiving aid. If such documents are not available, a school administrator, social worker, or case worker must sign the form to verify eligibility. 2. Submit applications by the deadline below via email to [email protected] or regular mail to: FINANCIAL ASSISTANCE APPLICATION HCYP Basketball P.O. Box 1662 Ellicott City, MD 21043 If you have any questions or concerns, please contact the Director of HCYP Basketball, Mr. BJ Borden @ [email protected]
1
Howard County Youth Program BASKETBALL FINANCIAL ASSISTANC APPLICATION
FINANCIAL ASSISTANCE APPLICATION – Important Information Funding is extremely limited therefore reduced rates are awarded on a first come first served basis. Assistance is also subject to space availability for each sports age groups. In order to provide a fair distribution of funds, some children in a family may not be granted assistance even if others are so that we may serve as many families as possible. The signature on the financial assistance application is an agreement that the parent/guardian/youth athlete will pay the required reduced amount to the program or request a refund before the program begins. A complete registration form is required prior to final awarding of the scholarship. The application also must be completed for consideration. All required information lines must be filled in completely and accurately with appropriate approval signature. SUBMIT COMPLETED APPLICATIONS TO FINANCIAL ASSISTANCE APPLICATION HCYP Basketball P.O. Box 1662 Ellicott City, MD 21043 HCYP Basketball must be paid in full at the reduced rate before the start date of the program or the youth athlete will not be able to participate. Fee Waiver: The youth athlete will have a substantial portion of the registration fee for HCYP Basketball waived. Typically, the youth athlete will pay 20% to 50% of the regular registration fee for HCYP Basketball.
2
Howard County Youth Program BASKETBALL FINANCIAL ASSISTANC APPLICATION
FINANCIAL ASSISTANCE APPLICATION – Completion Form Parents/Guardians: Complete this entire application with appropriate signatures and submit to the HCYP Basketball Director. If you are seeking assistance for one than one child, you must fill out a Financial Assistance Application for each child. Child’s Name: Parent/Guardian’s Name:
Gender:
Address:
Date of Birth:
Daytime Phone:
Howard County School Attending:
Cell/Evening Phone:
Current Grade:
Email address:
CONSENT TO RELEASE INFORMATION
I understand that personal and sensitive information may be needed to verify eligibility for HCYP Basketball financial assistance. Therefore, in order for HCYP Basketball to access information and coordinate services with other agencies, I agree that agencies may share information. I also certify that the information supplied is true and correct and that HCYP staff have my permission to verify the information on this application. I understand that my child’s participation in this program requires a commitment to attend a minimum of 50% of the scheduled practices and games.
REQUEST FOR A FEE WAIVER My child is currently enrolled in a public assistance program such as Free and Reduced Lunch, ADC, Foster Care, or Medicaid . I request a fee waiver for the HCYP Basketball Program and give my permission for the Dep artment of Family Services or the Howard County Public School System to release information verifying eligibility. I further understand that I must submit proof that I am receiving services.
Signature of Parent/Guardian:
Date:
A non-returnable copy of the official documentation signifying that the child is receiving aid must be attached. If documentation is not available, the following section must be completed and signed by a HCPSS school counselor or administrator, case worker or other official. I verify this applicant meets the HCYP Basketball financial assistance guidelines as specified above.
Name of Official:
Organization:
Address of Organization/School:
Position:
Signature and Date:
Phone:
SUBMIT COMPLETED APPLICATIONS TO FINANCIAL ASSISTANCE APPLICATION HCYP Basketball P.O. Box 1662 Ellicott City, MD 21043 3
