Financial Assistance Application - Town Select League

This Application is used to help determine eligibility for Financial Assistance for a Massachusetts Youth Soccer sponsored program. This information will be held in the strictest confidence and will not be disclosed to anyone other than the Program Director or Manager.

Massachusetts Youth Soccer Financial Assistance Program. *

Town Select League

Player's Name *

Player's Date of Birth *

Parent's Name *

Phone Number *

Street Address *

City *

State *

Zip Code *

Email Address *

Number of dependents in Player's family and their ages *

Please explain any special circumstances (e.g. extraordinary and unexpected expense, severe change in income, etc.) which adversely affect your ability to pay the fee for this particular Massachusetts Youth Soccer Program. *

Family Income Last Year *

How much financial aid are you seeking? *

50% of the program fee

25% of the program fee

other

Please describe the impact on the Player if he/she is not granted Financial Assistance. *

Massachusetts Youth Soccer seeks to bring the game of soccer to every child. Financial Assistance is based upon need. This Application for Financial Assitance is the only way Massachusetts Youth Soccer can determine such need. By checking below, you are certifying that the information contained in this Application for Financial Assistance is true and accurate. *

I certify the above information is true and accurate

Name of person submitting application *

Relationship to Player *