Shenandoah Valley United, Inc. AWS
Shenandoah Valley United, Inc. Center of Excellence and Competitive Financial Aid Application All financial aid requests will be reviewed by a committee and kept confidential. Past applicants approved for financial aid MUST reapply every year, with complete and current information. Please be aware that financial aid will not exceed 50% of the registration fees. No aid will be given for uniforms. **Email request to [email protected] or mail to Shenandoah Valley United 54 East Market Street Harrisonburg, VA 22801** Please Print. Use One Form Per Child. Season/Team/Division: _______________
Amount of aid requested: _____________
Player Information: Last Name: ______________________ First Name: __________________ MI: ____________ DOB: ________________
School Attending: _____________ Grade: ________________
Will Child Need New Uniform: ___Y or ___ N Primary Parent Information: Last Name: ______________________ First Name: __________________ MI: ____________ Street: _______________________ City: ____________________ Phone: _________________
Zip: _____________
(cell) ________________ Email: _________________________
Secondary Parent/Guardian/Contact Info: Last Name: ______________________ First Name: __________________ MI: ____________ Street: _______________________ City: ____________________ Phone: _________________
Zip: _____________
(cell) ________________ Email: _________________________
Financial Information Please Check One:
______ Own
______ Rent
______ Public Housing
Mortgage/Rent Payment: $__________ Household size (number of immediate family members living at player’s home) _________________ Does the player’s household receive Medicaid benefits (check one) ___Yes ____ No If “Yes”, a copy of your Medicaid card must be provided. Father’s Occupation: _________________________________________________ Employer: _______________________________ Income: $_________/per month Mother’s Occupation: _________________________________________________ Employer: _______________________________ Income: $_________/per month
By signing, I am stating that all information is true and accurate. I acknowledge that any financial aid that may be granted under this application will be forfeited in the event that the information herein is determined to be materially false. Father’s signature: ______________________________ Date: ________________
Mother’s signature: ______________________________ Date: _______________
FOR OFFICE USE ONLY
Approved By: ________________________________
Date Approved: _________________
____
Amount of Aid Approved: ________________________
Date Family Notified: __________________
Amount of aid requested: _____________
Player Information: Last Name: ______________________ First Name: __________________ MI: ____________ DOB: ________________
School Attending: _____________ Grade: ________________
Will Child Need New Uniform: ___Y or ___ N Primary Parent Information: Last Name: ______________________ First Name: __________________ MI: ____________ Street: _______________________ City: ____________________ Phone: _________________
Zip: _____________
(cell) ________________ Email: _________________________
Secondary Parent/Guardian/Contact Info: Last Name: ______________________ First Name: __________________ MI: ____________ Street: _______________________ City: ____________________ Phone: _________________
Zip: _____________
(cell) ________________ Email: _________________________
Financial Information Please Check One:
______ Own
______ Rent
______ Public Housing
Mortgage/Rent Payment: $__________ Household size (number of immediate family members living at player’s home) _________________ Does the player’s household receive Medicaid benefits (check one) ___Yes ____ No If “Yes”, a copy of your Medicaid card must be provided. Father’s Occupation: _________________________________________________ Employer: _______________________________ Income: $_________/per month Mother’s Occupation: _________________________________________________ Employer: _______________________________ Income: $_________/per month
By signing, I am stating that all information is true and accurate. I acknowledge that any financial aid that may be granted under this application will be forfeited in the event that the information herein is determined to be materially false. Father’s signature: ______________________________ Date: ________________
Mother’s signature: ______________________________ Date: _______________
FOR OFFICE USE ONLY
Approved By: ________________________________
Date Approved: _________________
____
Amount of Aid Approved: ________________________
Date Family Notified: __________________
