Financial Assistance (Scholarship) Application

Financial Assistance (Scholarship) Application
Parent/Guardian 1:*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Phone Number*
Please enter a valid phone number.
Home Phone Number
Please enter a valid phone number.
Work Phone Number
Please enter a valid phone number.
Email*
example@example.com

Parent/Guardian 2

First NameLast Name
Address if different than Parent/Guardian 2

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Phone Number
Please enter a valid phone number.

Assistance is being requested for the following child/Children:

Player:   First Name   Last Name   Division:

Player:   First Name   Last Name   Division:

Player:   First Name   Last Name   Division:

Player:   First Name   Last Name   Division:
Did your child/childnre participate in off-season hockey programs?
If yes, what programs?

Tax Reporting Filing Status*

Married Filing JointlyMarried Filing SeparatelySingleHead of HouseholdWidow
Size of Household:*
Number of Adults living in household:*
Number of children living in household:*
Total Household income for the year (from all sources)*
Total Household expenses for the year*
I will be willing to participate in volunteer hours if award scholarship*

YesNo

Please explain why financial assistance is needed. Provide as much information as possible.*

Authorization:

I herby certify that the information submitted on this form is true and correct, and I understand the Saints may verify the information on this application or ask for additional information. Providing false information will result in denial or financial assistance.
Signature Parent/Guardian 1*

Clear
Signature Parent/Guardian 2

Clear

Please attach most recent IRS federal income tax return 1040 or 1040A, including supporting tax schedules (if applicable). First 2 pages only please, black out any social security number. All information will be kept confidential and only viewed by the scholarship committee of the Saints Board of Directors.

Cancelof
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