Payving A Way Athletic Application

PAYVING A WAY

P.O. Box 831

Laveen, AZ 85339

info@payvingaway.org

payvingaway.org

(602)586-9359
youth athletics financial assistance form
Read and follow the instructions carefully prior to submitting your application. Please answer all questions to the best of your knowledge.
If selected, you will be asked for documentation to support the data you provide. Likewise, all correspondence and award agreements will be generated from the personal information submitted below.
I. Personal Information

Please fill out this section based on the recipient of the scholarship.
Full Name*

First NameLast Name
Birthdate*

MonthDayYear
Gender

MaleFemale
Parent/Guardian Full Name*

First NameLast Name
Parent/Guardian Mobile No*
Email *
Where the confirmation will be send to
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
II. Student and Athletics Information

Please fill out this section based on the recipient of the scholarship.
School Name
Grade
Sport(s) of Interest

BasketballFootballSoccerCheerleadingBaseballOther
Level of Experience

BeginnerIntermediateAdvanced
Briefly describe your involvement in sports, including any achievements or awards.

0/300
Submit your Report Card

Cancelof
III. Financial Background
Annual Household Income
Number of Dependents in Household
Please explain any financial challenges that you are currently facing.
Scholarship Amount Requested
IV. Reason for Assistance
Please describe the reason you are applying for assistance and how we can help.
If you'd like us to know any additional information, please provide it in the section below.

0/500
V. Applicant's E-Signature
By signing the space below, you are certifying that all information is correct and that you are the person completing this application. When you press the submit button, you will receive an email confirmation that your application was received. Please print for your records and retain as verification of your application.
Parent/Guardian Signature

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Payving A Way is committed to equal opportunity in opportunity and education. The non-profit does not discriminate in any program or activity on the basis of race, color, religion, gender, age, national origin, disability, marital status, or any other protected class.
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youth athletics financial assistance form

I. Personal Information

II. Student and Athletics Information

III. Financial Background

IV. Reason for Assistance

V. Applicant's E-Signature