Quad City Tennis Foundation

Quad City Tennis Foundation

Scholarship Application
Privacy Statement

All information will remain confidential and used solely for scholarship determination.
1. Player Information
Player's Full Name

First NameLast Name
Player's Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Gender (Optional)
School Name & Grade
2. Parent Information
Parent/Guardian Full Name

First NameLast Name
Parent's Contact Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent's Email Address
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
3. Tennis Background
How long has the player been playing?
Current Level
USTA/WTN Rating (If known)
Please provide current programs and tournaments the player has participated in.
4. Financial Needs Information
Reason for Requested Assistance
Household Income Range
Number of people in the household
Does the player qualify for free/reduced lunch at school?
Does the player receive assistance for other sports?

Other
Amount Requested
Requested Amount (If applicable)
5. Programming Requested
Which programs would you like assistance with?

Other
Intended Participation Level
6. Player Statement
Please tell us about the player, their interest in tennis, goals, and how this assistance will help.
7. Recommendation
Recommender Name

First NameLast Name
Relation to player
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
8. Commitment Agreement
By submitting this application, we agree:
9. Media Release
10. Signatures
Parent/Guardian Signature
Signed Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Player Signature
Should be Empty:

Quad City Tennis Foundation

Privacy Statement

1. Player Information

2. Parent Information

3. Tennis Background

4. Financial Needs Information

5. Programming Requested

6. Player Statement

7. Recommendation

8. Commitment Agreement

9. Media Release

10. Signatures