SGMHA Financial Assistance Form

Application Form and Guidelines

Closing Date for Applications: September 30
Spruce Grove Minor Hockey Financial Assistance: Confidential Spruce Grove Minor Hockey Financial Assistance Application Form

Please read the guidelines for Applicants carefully before completing this form. The form should be completed using black ink or word-processed. It should reach the SGMHA office by September 30. If completed by hand, please use BLOCK CAPITALS
Name*

FirstGiven NamesSurnameFamily Name
Date of Birth*

MonthDayYear
Date
Player's Names*
Member Full Address including postal code*
Phone Number*
Reason for requesting assistance*
Are you willing to work bingo shifts?*

YesNo
Are you willing to do other volunteer work to help cover fees? Ex: casino, if available, playoff games, etc ?*

YesNo
Have you applied to KidSport or Jumpstart?*

YesNo
Please indicate where you have applied and contact name
Section 2 - Financial Information
Total Income*
Mortgage/Rent*
Power*
Heat*
Water*
Groceries*
Other Expenses: Please list*
If more room is required:
You will be required to provide proof of expenses along with bank statements. These will be held in strict confidence. Please email income validation and expense receipts.
Section 3 - Personal Statement
Using the space provided, give reasons why you believe you should be considered for Financial Assistance from Spruce Grove Minor Hockey.*
It has been completed by give name*
I understand that the information I have provided will remain confidential to the SGMHA Administrator.I confirm that the information I have provided is accurate, and understand that the provision of false information may lead to the withdrawal of application.
Signature*

Clear
Date*

MonthDayYear
Date
Have you completed all sections of the application form? Have you provided all documentation required? Have you signed and dated your application form?
The completed application form should be submitted to arrive no later than 30 September, to: SGMHA Box 3666, Spruce Grove, AB T7X 3A9 You will receive correspondence acknowledging receipt of your application.
Should be Empty:

Section 2 - Financial Information

Section 3 - Personal Statement