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Fall 2019 Financial Assistance Request
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* Indicates required question
Player's First Name:
*
Your answer
Player's Last Name:
*
Your answer
Player's Phone Number:
*
Your answer
Gender:
*
Choose
Male
Female
Age Group:
*
Age group you are participating with.
Choose
U9
U10
U11
U12
U13
U15 Non-High School
U16
U19
Community:
*
Choose
Bath
Charlotte
Clinton
Columbia
Dansville
DeWitt
East Lansing
Eaton Rapids
Fowlerville
Grand Ledge
Hanover Horton
Haslett
Hillsdale
Holt
Ionia
Jackson Celtic
Jackson County Western
Jackson NW
JACS
Laingsburg
Lakewood
Lansing Soccer Club
Leslie
Manchester
Maple Valley
Mason
Okemos
Olivet
Ovid-Elsie
Owosso
Portland
St. Johns
Stockbridge
Waverly
Williamston
OTHER
Team Name:
*
Your answer
Coach's First Name:
*
Your answer
Coach's Last Name:
*
Your answer
Coach's Email:
*
Your answer
Amount Requested:
*
CASL allows up to $75/season
Your answer
Reason for Request:
*
Your answer
Person Requesting Request
First Name:
*
Your answer
Last Name:
*
Your answer
Email:
*
Your answer
Phone Number:
*
Your answer
Relationship to Player:
*
Choose
Parent/Guardian
Coach/Asst. Coach/Manager
Other
Address Check Should Be Sent To
First Name:
*
Your answer
Last Name:
*
Your answer
Address:
*
Your answer
City:
*
Your answer
Zip:
*
Your answer
Submit
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