Financial Assistance Request Form 2017/18

1 Financial Assistance Request form 2017 /18 Requirements: Aid applications must include a copy of the parents prior year tax return as proof of income, and a statement of extenuating circumstances the applicant wishes to be considered. No application without a Tax return and Statement of need will be considered. Please dark out your social security numbers. When requesting aid for multiple players, please submit one form per player you are requesting aid for. All accompanying documentation must also be submitted per application.

2 Multiple player discount does not apply to accounts receiving Financial aid. All scholarship recipients are required to provide volunteer hours during tournaments and events during the year. An application does not imply approval. Scholarship applications may be denied or partially approved. Notification of Financial aid will take place by June 30th. Financial aid Request form must be postmarked no later than June 24th. No requests will be granted for submissions made after this date. Player s Name: _____ Phone #:_____ Address: _____ City: _____ZIP_____ Team_____ Age Group/Gender_____ Number of consecutive seasons with Rush: _____ Number of children in the family: _____ Parents: Married _____ Single _____ Annual Salary: Adult 1: $ _____ Adult 2: $ _____ Other sources of income.

3 Child Support $_____ Social Security $_____Other source $_____ **Attach prior year tax return as proof of income (please mark out SSN)** Does your child qualify for free/reduced school lunch? _____ School District_____ Does your family qualify for State Food Assistance (MI-Bridge Card)? Yes / No Does your family receive SSI or SSDI income? Yes / No Does your family receive Medicaid benefits? Yes / No If you could not answer yes to one of the above questions, please, reconsider applying. Our funds are extremely limited and we will disburse funds by degree of the demonstrated economic need.

4 Brief description on need for funds or special circumstances * required please print legibly: _____ Use this Financial Assistance Matrix to calculate the level of support you are requesting: Part A: Age Group and Annual Fee Part B: Requested Percentage of Assistance U16-18 Boys/Girls: $1380 U15 Boys/Girls: $1880 U13-14 Boys/Girls: $2050 U11-12 Boys/Girls: $1965 U9-10 Boys/Girls: $1020 10% Assistance = .9 20% Assistance = .8 25% Assistance = .75 40% Assistance = .4 50% Assistance = .5 Calculate Total Club Fee Capable of Paying: Full Club Fee from Part A $_____ Requested Percentage of Assistance from Part B (ex: 25 % Assistance =.)

5 75) _____ Requested Fee to be paid by club ( Financial Aid Amount): $_____ Fee to be paid by parents: $_____ To Calculate, multiply the full fee for the correct age group (Column A) times requested Assistance (the decimal number in Column B) Ex: $2050 (U14G) x .75 (25% Assistance ) = $ fees to be paid by family and $ to be paid by club in the form of a scholarship. Please note: You are still required to register with the online payment system by the required date, even if scholarship awards have not been announced.

6 Any scholarship awarded will be deducted from the yearly fees after the family is registered. Failure to register by the required date may cause a loss of scholarship funds and trigger a late payment fee that is not refundable. Financial Aid is NOT guaranteed and only applies to Club Fees. Please note: if requesting Financial aid, your family remains responsible for all required uniform fees, referee and additional tournament fees pertaining to your team. All club fees will be collected after the club has responded with the level of Financial aid your family will receive.

7 A payment plan will be offered to your family outlining the amount of money due, along with when it is due. Failure to meet the minimum monthly payments may result in loss of Assistance and/or removal from the program. I declare the above personal and Financial information is accurate and I will submit my most recent federal income tax form with this Request . I understand that receiving Financial Assistance is a privilege, and I pledge to have my child at all team activities with soccer as a priority over other athletic activities.

8 I pledge for my family and/or I to volunteer at club events as assigned by the club directors. Failure to honor commitments may result in loss of Assistance and/or removal from the program. I also recognize the scholarship may cover partial fees and I am responsible for paying the remaining balance. I am responsible for non-club expenses (personal travel, extra events/expenses outside club fees, uniforms, tournaments ref fees, etc.) Parent(s) signature: _____ Date:_____ All information submitted and any Financial Assistance granted will be kept strictly confidential by Michigan Rush Soccer Club.

9 Completed applications can be mailed to: Rush Lansing, PO Box 373, Holt, Michigan 48842, or dropped off at Club Registration Night. APPLICATIONS are due and should be postmarked no later than June 24th, 2017 . No applications after this date will not be considered.