Corte Madera FC Scholarship Fund Application
APPLICATIONS
To be considered for a scholarship please complete all required fields, including income verification, and submit the form.
Information provided will be used by the Scholarship Fund to review applications and allocate available funds based on the relative financial need of each family.
Applications may be shared with the Town of Corte Madera, which administers the Corte Madera FC program, as part of the decision-making process.
Applications and supporting materials will be kept strictly confidential and will be destroyed after awards are granted.
AWARDS
Scholarship awards will be in the form of fee subsidies toward registration and program costs for participation on a Corte Madera FC team. These costs typically range from approximately $1,000 to $2,000 depending upon the player's age group. Awards will not cover 100% of program fees.
Families are responsible for all additional costs, such as team fees (which include tournament fees) and equipment.
No funds will be paid directly to families.
Applicants must re-apply for assistance each year. Awards may vary from year to year and granting of a previous award is not necessarily an indicator of a future award.
Player Information
Player #1 name
*
First Name
Last Name
Player #1 date of birth
*
-
Month
-
Day
Year
Date
Player #2 name
First Name
Last Name
Player #2 date of birth
-
Month
-
Day
Year
Date
Player(s) town or city of residence
*
Primary Contact Person
Name of primary contact person
*
First Name
Last Name
Primary contact person's relationship to player(s)
*
Mother
Father
Other family member
Family friend
Other
Primary contact person's email
*
example@example.com
Primary contact person's phone number
*
Please enter a valid phone number.
Primary contact person's mailing address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Secondary Contact Person (optional)
Name of secondary contact person
First Name
Last Name
Secondary contact person's email
example@example.com
Secondary contact person's phone number
Please enter a valid phone number.
Financial Assistance
Copy of most recent tax return (e.g. IRS Form 1040, W-2, 1099)
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Unable to provide income verification? Please provide a brief description of your circumstances.
Number of people in player(s) household
*
1
2
3
4 or more
Adults
Minor dependants
Amount you can pay toward Corte Madera FC registration and program fees (please review the Corte Madera FC website for details of program fees for your age group)
*
Amount of fee subsidy you are requesting toward Corte Madera FC registration and program fees
*
Participation Agreement
If you receive a scholarship award, would you be willing to provide feedback to the Corte Madera FC Scholarship Fund to help improve the application process for future participants?
*
Yes
No
If you receive a scholarship award, would you be willing to provide a testimonial to help future participants understand the value of the program? Testimonials may be made anonymously, if preferred.
*
Yes
No
Signature
Signature of person responsible for this application. By signing the form, you affirm that all information provided is true and accurate.
*
Date of signature
*
-
Month
-
Day
Year
Date
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