Scholarship Request FormAdmin2026-07-11T16:02:38-04:00 Email Address *Parent/Guardian's Name *Contact Number *Street Address *Apartment, suite, etcCity *State *ZIP / Postal Code *Please select the sport that you are requesting scholarship assistance for: *Baseball/SoftballBasketballCheerleadingStreet/Floor HockeySoccerWrestlingOtherChild's Name *Child's Date Of Birth *MonthSelect month123456789101112DaySelect day12345678910111213141516171819202122232425262728293031YearSelect Year20242023202220212020201920182017201620152014201320122011201020092008200720062005Child's School Attending? *Confidential InformationPlease 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.What is your annual household income? *What is the size of the household? *Is a payment plan an option instead of a scholarship? *YesNoWhat is the maximum amount you can pay towards registration fees? *Do you receive or qualify for the Free and Reduced-price meals program through the school district? *YesNoIf awarded with a scholarship, would you be willing to volunteer in some capacity to Premier Athletics? *YesNoPlease explain your request/circumstances: *Current Employer: *CONSENT TO RELEASE INFORMATIONConsent and Release *I have read and agree to the 'consent to release information' terms and conditions as outlined below. 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. Submit
