Southeast Elite Soccer Academy
Southeast Elite Soccer Academy Financial Assistance Request Form 1. Player’s First and Last Name: ______________________________________________________________________________
2. Parent(s)/Guardian(s) First and Last Names: ______________________________________________________________________________
3. Address (street, city, state, zipcode): ______________________________________________________________________________
4. Other siblings playing for SESA? Please list name(s) and team(s): ______________________________________________________________________________ 5. Number of people living in the household: ________________
6. Verification of yearly income (a copy of last year’s taxes). Please attach to this form.
7. Please tell us why you need financial assistance from SESA:
Please initial next to each statement that you understand and agree to the information below:
___ 1. I understand we need to fundraise half of our yearly fees to receive financial assistance from SESA. Only after we fundraise the first half of our yearly fees will SESA pay our remaining half. ___2. If we do not fundraise our half of the yearly fees, I will then owe the full year’s fees. ___3. I understand I must set up a monthly payment plan between SESA and my bank before the fall season begins. Once I fundraise my half of the yearly fees, the other half will be taken off the remaining balance of my child’s SESA account. ____4. I understand that it is SESA’s policy that if we accept financial assistance from SESA, this player will not be able to participate in optional tournaments with a SESA Elite team which require additional fees above the yearly fees. This includes winter indoor tournaments. _____________________________________________________________________________ Parent Signature
Date
2. Parent(s)/Guardian(s) First and Last Names: ______________________________________________________________________________
3. Address (street, city, state, zipcode): ______________________________________________________________________________
4. Other siblings playing for SESA? Please list name(s) and team(s): ______________________________________________________________________________ 5. Number of people living in the household: ________________
6. Verification of yearly income (a copy of last year’s taxes). Please attach to this form.
7. Please tell us why you need financial assistance from SESA:
Please initial next to each statement that you understand and agree to the information below:
___ 1. I understand we need to fundraise half of our yearly fees to receive financial assistance from SESA. Only after we fundraise the first half of our yearly fees will SESA pay our remaining half. ___2. If we do not fundraise our half of the yearly fees, I will then owe the full year’s fees. ___3. I understand I must set up a monthly payment plan between SESA and my bank before the fall season begins. Once I fundraise my half of the yearly fees, the other half will be taken off the remaining balance of my child’s SESA account. ____4. I understand that it is SESA’s policy that if we accept financial assistance from SESA, this player will not be able to participate in optional tournaments with a SESA Elite team which require additional fees above the yearly fees. This includes winter indoor tournaments. _____________________________________________________________________________ Parent Signature
Date
