EBSA Financial Assistance Application

EBSA Financial Assistance Application

Complete this application to request financial assistance for your player and family.
Parent / Guardian Information
Parent / Guardian Full Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Player Information
Player Full Name
Player Age
Season
Is the player a returning EBSA participant?
SECTION 3 — Assistance Requested
Type of Assistance Requested
If requesting partial assistance, how much can you contribute?
Briefly describe your financial need
Number of children participating in EBSA this season
SECTION 4 — Volunteer Participation (Recommended)
Volunteer areas
Best day/times you are available to volunteer
Agreement & Certification
I certify that the information provided is true and complete. I understand that EBSA offers financial assistance based on available funds and that all awards are determined by the EBSA Board.
I agree
Should be Empty: