Applicant Details:
Must be registered with Hockey Equality to apply. Please fill all sections of this application where applicable.
Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Name of Parent/Guardian
*
First Name
Last Name
Name of Parent/Guardian
First Name
Last Name
Phone Number
*
Format: (000) 000-0000.
E-mail
*
example@example.com
You may add a photo of the applicant here.
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Team Information
*
Team Name
Team Level
Name of Head Coach
*
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Team Manager's Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
If you have a letter of recommendation from your team staff please provide it here.
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Have you ever been subject to disiplinary action by your coach, team, organization or league?
*
Yes
No
If you answered Yes, please explain.
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Impact
Please give an impact statement about why this financial assistance is essential and impactful.
If you have a Letter of Impact from Applicant or Parent please provide it here
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Are you receiving any other financial aid/scholarship or similar?
*
Yes
No
If you answered yes to the above question, please give details below.
Do you identify as any of the following:
BIPOC (Black, Indigenous, Person of Color)
Female
Disabled
Marginalized
Low Income
Equity Deserving
If you identify as any of the above, please explain here.
Please give reference of any two people whom you feel would be advocate for you about the impact of financial assistance:
Rows
Full Name
Contact email
1
2
If your application indicates you are applying based on low income, please provide a declaration of income letter or any other relevant documentation.
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Education
Name of current School
*
Address of School
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What are your current grades?
If you have a letter of recommendation from a teacher or school administrator please provide it here.
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Have you ever been subject to disciplinary action by your school or teachers?
*
Yes
No
If you answered Yes, please explain
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Please provide information on the team/program you are applying for and what the total financial requirement is.
What is your requested grant amount?
I,
blanks
hereby declare that the information provided in this application is true and correct.
Signature
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Submit
Should be Empty: