Scholarship Application
Posted Feb 12, 2014

Gate City Youth Soccer League Financial Assistance/Scholarship Request Form

In order to accurately determine need and allocate the limited financial assistance funds of the Gate City Youth Soccer League, you must complete the following application form. Priority consideration will be given to applications received by the stated registration deadlines and to those residing within GCYSL boundaries. Anyone requesting more than 25% of a players fees will be required to meet with the Scholarship Committee and provide additional financial and other information. An initial deposit is required and non-refundable. The initial deposit,fees, and scholarship money available may vary from year to year. All information is confidential.

1. Child’s Name:_____________________________Amount Requested:________________________

2. Age/Division:______________________________________________________________________ Date of Birth:_____________________________Gender:__________________________________

3. Parent(s)Name:_____________________________________________________________________ Address:___________________________________________________________________________ Home Phone:________________ Cell Phone:________________Email:_______________________

4. Please state your reason(s) for applying for soccer fee assistance including any special circumstances of which this committee should be aware:_________________________________ __________________________________________________________________________________ __________________________________________________________________________________

5. Does anyone in your family receive free or reduced lunch?________ if yes please attach a copy.

6. What is your average household income?_______________________________________________ (If parents are not living in the same home please include income for both parents)

7. Has anyone in your family received a player scholarship in the past?________________________ If so, please provide the date(s), player name, and amount of scholarship(s): _______________ __________________________________________________________________________________

SCHOLARSHIP VOLUNTEER CLAUSE: If financial assistance is provided, you as the parent/guardian are required to volunteer up to 4 hours in support of the Gate City Youth Soccer League, which may include setting up or taking down nets, helping clean up or maintain fields, and other activities as needed by the GCYSL or your child's team. If you do not complete your volunteer work or your child does not participate in practice and games at least 75% of the season you will have to reimburse GCYSL the amount of the scholarship awarded and will be denied financial assistance in the future.

Please initial here________________ that you have read and understand the Scholarship Volunteer Clause.

If financial assistance is approved, it is understood the GCYSL will pay only toward the player registration fees. Other expenses including those for players participating in the Select Team programs or Competitive teams will be the responsibility of the parent/guardian. Scholarships awarded may be up to 25% of registration fees unless special circumstances are presented to the Scholarship Committee and then they may be up to 100% the first season and reduced by 25% or more each subsequent season. The Scholarship Committee, on a case-by-case basis, will review special circumstances.

Parent/Guardian Signature:________________________ Date:____________________

OFFICE USE ONLY APPROVED:______YES ______NO AMOUNT:________ DATE OF NOTIFICATION:__________