Financial Assistance Application Form

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Minot Soccer Association (MSA) has established a financial assistance program for rec and competitive soccer players who are eligible to participate on a Magic City Legends, Junior Legends Academy, or Recreational team. This financial assistance program is funded by income received during club fundraiser activities and donations. By filling out this form you have agreed that you are eligible by having read the above linked Financial Assistance Requirements.

**You need to fill out a form for EACH ATHLETE**

Email *

First and Last Name of the athlete *

Age of the athlete *

How many years as this athlete played soccer for MSA? *

How many people currently reside in the household? *

Please list the name and ages of all the children playing soccer for MSA in the household. *

Program you are applying for assistance *

Mother First Name *

Mother Last Name *

Mother Address *

Mother Cell Phone Number *

Mother Place of Employment *

Mother Annual Salary *

Father First Name *

Father Last Name *

Father Address *

Father Cell Phone Number *

Father Place of Employment *

Father Annual Salary *

Does anyone in the household qualify for Medicaid, FoodStamps, SSI, WIC or free/reduced lunch? *

Yes

Required

If the answer was yes, please list the government assistance you qualify for. *

Please provide a brief explanation of the financial situation in which your family finds the need for financial assistance. *

Signature. By typing your name below you are certifying that all the above information to be true to the best of your knowledge. *

Submit

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