Financial Assistance Application

PLAYER INFORMATION

Player's Name *

FC Storm Team *

Number of Children Playing for FC Storm (including Premier and Academy) *

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

Parent/Guardian Name *

Mailing Address *

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Phone *

Marital Status *

Employer *

Annualized Family Income *

USD

Spouse/Partner Employer

Amount Requested

USD

If requesting less than the full team/club fees.

Reason for the Request *Please include any information that helps explain the basis for the financial request.

I understand the financial scholarship award is subject to funds available and the family’s financial status.

I 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 *