Scholarship Application

CSAHA Scholarship Application

The information provided on this form is private and confidential.
All Sections Marked With An Asterisk Are Required
Player Information
Player Name*

First NameLast Name
Player Birth Date*

MonthDayYear
Date
Season Scholarship is For*
Enter season as yyyy-yyyy
Player USA Hockey Number*
Enter a USA Hockey Number that is current for the season this application is for.
Program Player Plans to Participate In:*

Tier IITravelRecreationalGirls8 & Under
Scholarship amount applying for:*
Enter the scholarship amount you are applying for.
Parent 1 Information
Parent 1 Name*

First NameLast Name
Parent 1 Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Parent 1 Contact Phone*

Area CodePhone Number
Parent 1 Email*
Please ensure you can receive emails from the "csaha.com" domain.
Marital Status*
Please choose your marital status.
Number of Dependents
Must correspond with tax document submitted.
Parent 1 Employer*
Employer Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Employer Phone*

Area CodePhone Number
Length of Employment*
Parent 2 Information

Please complete this section if there is second parent/guardian responsible for the player named in this application.
Parent 2 Name

First NameLast Name
Parent 2 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent 2 Contact Phone

Area CodePhone Number
Parent 2 Email
example@example.com
Marital Status
Please choose your marital status.
Number of Dependents
Must correspond with tax document submitted.
Parent 2 Employer
Parent 2 Employer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Employer Phone

Area CodePhone Number
Length of Employment
Family Income & Expense
Total Monthly Income*
Enter the total amount of gross monthly income from all sources for your household. Must correspond with tax or proof of income document submitted.
Other Monthly Income*
Enter other monthly income you receive, or enter 0 if none.
Total Household Monthly Expense*
Enter the total monthly expense for your household.
Total Disposal Income
This is the amount you have left after subtracting your monthly expense from your income.
Other Information
Will your player be able to participate in CSAHA programs without scholarship assistance?*

YesNo
Will you commit to participating in all CSAHA fundraising events?*

YesNo
Will you commit to your player attending all away and tournament games?*

YesNo
Please write a brief paragraph noting any other information you consider important in regards to this scholarship application.

0/300
Supporting Documents

Supporting documents MUST be submitted in order for your application to be considered. Please read the document descriptions carefully to submit the correct forms as requested.
Please attach the FIRST 2 PAGES ONLY of your most recent Federal Income Tax Return (Form 1040, 1040-A, or 1040-EZ). If you do not file Federal Income Tax Returns, please attach your most current proof of income*

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Acceptable file types are: pdf, doc, docx, txt, rtf, jpg, jpeg, png, gif Cancelof
Please attach your most recent annual financial statement. *

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Most banks will provide a financial statement form for their customers. Forms can also be found online by searching for "online annual financial statement form". Cancelof
Please attach a Letter of Recommendation FROM your player's most recent coach. This brief recommendation should touch on the player's attitude, teamwork, etc. This letter needs to be written by the coach providing it and is required for your application to be completed. Other documents may not be substituted.*

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Acceptable file types are: pdf, doc, docx, txt, rtf, jpg, jpeg, png, gif Cancelof
Terms & Conditions for a CSAHA Scholarship

Scholarship applications are due by July 31st. This helps us determine how best to allocate available scholarship funds.

Players must be registered for the program they wish to participate in for their application to be considered.

CSAHA's Scholarship Committee will review all applications received and award scholarships shortly before the beginning of each hockey season. Applicants will be notified by email of the committee's decision.

Scholarships are awarded for the current season only. A new application must be submitted for each season.

All applications MUST include the supporting, fully completed, documents as requested in order to be considered.
Player Signature*
By typing your name in the box above you are confirming that the information provided in this application is true and correct, and that you are committing to fully participating in the CSAHA program chosen above.
Parent 1 Signature*
By typing your name in the box above you are confirming that the information provided in this application is true and correct, and that you agree to the Terms & Conditions should your player be awarded a scholarship.
Parent 2 Signature
Must be signed if a second parent is named above. By typing your name in the box above you are confirming that the information provided in this application is true and correct, and that you agree to the Terms & Conditions should your player be awarded a scholarship.
Please check that all items have been completed.*
Should be Empty:

CSAHA Scholarship Application

Player Information

Parent 1 Information

Parent 2 Information

Family Income & Expense

Other Information

Supporting Documents

Terms & Conditions for a CSAHA Scholarship