Scholarship Assistance Request

Email^*

Enter email again^*

Child's Full Name:^*

Child's school attending:^*

Please select the sport that you are requesting scholarship assistance for:^*

Billing Address:^*

Street Number

Street Address

City

State

Country

Zip Code

Parent/Guardian's Full Name:^*

Parent/Guardian's Contact Number:^*

What is your annual household income?^*

What is the size of the household?^*

What is the maximum amount you can pay towards registration fee?^*

Do you receive or qualify for the Free and Reduced-price meals program through the school district?^*

Is a payment plan an option instead of a scholarship?^*

If awarded with a scholarship would you be willing to volunteer in some capacity to Premier Athletics?^*

Please explain your request/circumstances:^*

Current Employer:^*

Please ensure all information is complete and correct. Any personal information that you are required to provide will be kept confidential within the Board of Directors.

CONSENT TO RELEASE INFORMATION^*

I understand that by agreeing to the 'consent to release information' it authorizes Premier Athletics for Youth Development 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’s participation in this program requires a commitment to attend a minimum of 80% of the scheduled practices and games. I agree to notify the Premier Athletics for Youth Development 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.

I have read and agree to the 'consent to release information' terms.

Scholarship Request Form

Scholarship Request Form

Scholarship Assistance Request