Storm Elite Scholarship Assistance Application

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* 1. Participant Name:

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* 2. Parent/Guardian Name:

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* 3. Please select which program you are requesting assistance:

Football

Cheer

Age Group/DOB of player

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* 4. Address

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

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* 5. What is the annual household income?

Under $15,000

Between $15,000 and $29,999

Between $30,000 and $49,999

Between $50,000 and $74,999

Between $75,000 and $99,999

Between $100,000 and $150,000

Over $150,000

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* 6. Household Size:

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* 7. Please explain your request/circumstances:

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* 8. Receiving assistance from programs such as:

Food Stamps

Medicaid

Foster Care

SSI

WIC

Section 8 Housing

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* 9. The Board of Directors will review your application and determine if you qualify for an award. . Please make sure all information is complete or correct. Any personal information that you are required to provide will be kept confidential within the board of directors.

I understand that if I receive a partial scholarship I am responsible for paying the other portion of the scholarship. I understand that if I receive a full scholarship that includes a uniform, the uniform is to be returned at the end of the season. The uniform rental does NOT included a gear bag or compression shirt, those are available to purchase but those are not available as part of the scholarship uniform.

CONSENT TO RELEASE INFORMATION

I understand that my signature authorizes Jacksonville Onslow Legacy Football Association to obtain verification of all the information on this application and that additional information may be necessary for approval of this application. I certify that all of the information on this form is true and correct. I understand that my child(ren)’s participation in this program requires a commitment to volunteer for Jacksonville Onslow Legacy Football as needed. I understand that failure to follow the Jacksonville Onslow Legacy Football Association’s Scholarship agreement will revoke my scholarship, and my child will be removed from the program. I agree to notify Jacksonville Onslow Legacy Football Association of any change in my income or ability to pay. I am aware that assistance funds are awarded for a maximum of one year, after which time it is my responsibility to reapply. By signing below, I agree to the consent to release my information, and also state the information submitted in this application is accurate. I understand falsifying information in this application will result in a loss of scholarship.

Yes

No

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* 10. Parent/Guardian Name/Signature: