FC Storm Financial Assistance

PLAYER INFORMATION

All information provided to the Committee will be confidential.

Player's Name *

FC Storm Team *

Total Season Fee

USD

Coach's Name *

Number of Children Playing for FC Storm *

Number of Children Playing Competitive Sports (soccer, baseball, basketball, etc.)

PARENTAL INFORMATION

Parent/Guardian Name *

Mailing Address *

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Phone *

Marital Status *

Employer *

Annualized Salary *

USD

Parent/Guardian Name

Mailing Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Phone

Marital Status

Employer

Annualized Salary

USD

FINANCIAL REQUEST

Amount Requested *

USD

Reason *

Do any of your children receive scholarships to play competitive sports? *

If yes, why? *

USD

Please state any unusual circumstances you believe warrant awarding your child a need-based scholarship. *

Form Section

A agree to mail a copy of my most recent Federal Tax Return, which is required to apply for a scholarship. All information provided to the Committee will be confidential.

Federal Tax Returns should be mailed to:

Loveland Storm Scholarship Committee
c/o Bruce Jones
12083 Stone Point Court
Loveland, OH 45140

I understand the financial aid amount is subject to funds available and the family’s ability to pay.

I have provided all required income documentation and certify that the information I have provided is true and accurate to the best of my knowledge.

Name of person completing this form *

Date Completed *