SCUFC/YMCA Financial Assistance Application (Fall 2020 season)

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Parent First Name *

Parent Last Name *

Contact Email *

Contact Phone Number *

Include area code

Number of children in family playing SCUFC/YMCA Recreational Soccer *

Player's Name(s) - Please list the names of all children playing *

Venue Playing *

Ballentine Park

Polo Road Complex

Downtown YMCA

Jeep Rogers YMCA

North West YMCA

Household Income *

Less than $25,000/year

$25,000 - $30,000/year

$30,000 - $35,000/year

$35,000 - $40,000/year

$40,000 - $45,000/year

$45,000 - $50,000/year

More than $50,000/year

Amount to be paid by applicant/child *

$25/player

$30/player

$35/player

$40/player

$45/player

$50/player

$55/player

$60/player

$65/player

$75/player

Federal or State Aid you are currently receiving (please select all that apply) *

School District Reduced or Free Lunch Plan

Medicaid

Food Stamps

N/A - I am not receiving any Federal or State Aid

Required

Please list any UNUSUAL financial obligations or hardships (i.e. Medical bills, recent loss of job).

I agree that everything stated in the above application is correct to the best of my knowledge. I also agree to provide verification of income, if requested. *

Yes

I understand that I must be current with any outstanding balances due to SCUFC or SCUFC/YMCA before I will be awarded further assistance. I also understand that Payment of any balance due on the account MUST be paid in full before my child will be allowed to practice/participate in games. All decisions of the Financial Assistance Committee are FINAL. *

Yes

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