Mandeville Soccer Club - SportsEngine

1 Mandeville Soccer club 790 Florida Street, Mandeville . Louisiana . 70448 telephone: telefax: e-mail: financial assistance request Mandeville Soccer club offers a financial assistance program for players who need financial assistance in order to participate. Recipients of financial assistance will be required to provide a limited number of volunteer hours to the club . These hours primarily will be required during the club s annual Halloween tournament, however, there will be additional events/activities at which the hours can be completed.

2 Any recipients not fulfilling the required volunteer hours during the year of award will not be eligible for financial assistance in the subsequent years. Please state your reasons for requesting financial assistance , attach necessary documentation listed below and the MSC Treasurer will review the request to determine eligibility. DATE: _____ AGE GROUP AND GENDER: _____ NAME OF PLAYER: _____ ADDRESS: _____ CITY/ZIP:_____ TELEPHONE: H_____ C_____ EMAIL: _____ ARE YOU PRESENTLY ON financial assistance ?

3 YES NO Please provide the following with the understanding that all information will be kept confidential: W-2 for prior 2 years Tax returns for prior 2 years SNAP (Supplemental Nutrition assistance Program) Medicaid Card Free or reduced lunch program Number of children playing at MSC: _____ Extenuating circumstances please give details _____ _____