Scholarship Application Form

AYSO Region 1031 Scholarship Application Form

Before completing the scholarship application form, you MUST complete the following steps:
1) Complete the player application form. www.ayso1031.org/registration (skip the payment option)
2) Complete the volunteer application form. http://www.ayso1031.org/volunteers/becomeavolunteer
The scholarship application will not be processed without steps 1 and 2 complete.

Apply early as grants are limited. You will be notified once your scholarship is approved.

Player Information:

1. Player's Name

2. Birth Date mm/dd/yyyy

3. Grade

4. Age

5. Address

5a. City

5b. State

5c. Zipcode

6. Gender Male Female

7. Ethnicity

8. How did you hear about our scholarship program?

Parent/Guardian Information:

9. Name

10. Work Phone

11. Home Phone

12. Parent Address

12a. Parent City

12b. Parent State

12c. Parent Zipcode

13. Email

14. Please indicate whom your child lives with

15. I have completed a volunteer application form ? Yes No

Note. See information above about the application submission process.

Financial Background:

16. Is your child receiving/eligible for free or reduced school lunch? Yes No

17. Annual household gross income: $
• Do not include dollar sign ($).
• Commas (,) are allowed.
• All cents (.99, .50) must be entered with a leading zero 0, (0.99, 0.50).
• Please enter a value in the following formats: 1,234.56 or 1234.56 or 1234 or 0.

18. Number of people living in household

19. How much can you pay per child? $
• Do not include dollar sign ($).
• Commas (,) are allowed.
• All cents (.99, .50) must be entered with a leading zero 0, (0.99, 0.50).
• Please enter a value in the following formats: 1,234.56 or 1234.56 or 1234 or 0.

Additional Information:

20. Please provide us some information about your financial or other situation that will assist us in our decision

21. Have you received a scholarship for this Player from AYSO in the past? Yes No

22. Paycheck stubs of all adults in the household are required for final confirmation of need. Please upload them in a SINGLE FILE below. (.doc,.docx, .jpg or .jpeg, .PDF) (Accept file size up to 25 MB)

Parent/Guardian Signature:

23. I have answered the above questions to the best of my ability. I have been honest about the family's situation. Full Name Date

Youth Soccer. Ladera Heights - Baldwin Hills - View Park - Inglewood - Jefferson Park
AYSO National Area 1P

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