Application for Financial Assistance

Step 1:Download this application

Step 2: Attach (1) a copy of a current pay stub or your tax return (2) the application fee ($20 for recreational players, $100 for competitive players). The application fee will go directly towards your registration fee

Step 3:Fill out this application and turn it into the St. Vrain FC (SVFC) officewith the required financial informationand application fee. Tax returns or pay stubs are required for Competitive players, lunch vouchers are all that is required for Recreational players.

------

I am requesting a scholarship for the following children:

Child’s Name Age Group/Birth YearTeam/Program (ex: U10 Rec Travel Tigers)

______

______

______

______

Family / Last Name: ______Date: ______

Current Address: ______

Parent / Guardian Name(s): ______

Email Address: ______

Total number of persons living in household: ______Phone: ______

Your familyincome from work before deductions for taxes and social security

$0 – $20,000

$20,001 – $25,000

$25,001 – $30,000

$30,001 – $35,000

$35,001 – $40,000

$40,001 – $50,000

$50,001 – $60,000

$60,001 – $70,000

$70,001 or more

**If the above information and your taxes/paystub/lunch voucher do not fully explain your financial situation, please submit a letter with this application so we can fully assess your needs.**

With this application I have included:

Copy of current pay stub (for Competitive players)

Copy of your latest tax return (for Competitive players)

Copy of School Lunch Voucher (for Recreational players only)

For Competitive U11+ Players Only

Scholarship players are now able to reduce their balance with SVFC through our Work/Play program. The more time you are able to volunteer/work, the more financial aid SVFC is able to offer.

SVFC is no longer ordering uniforms for players. If your U11+ player needs a uniform, we will reduce your registration fee to compensate for that cost. You are responsible for ordering a uniform for your player(s).

Please see the table below to choose how to donate your time and for a breakdown of howyour balance will be reduced through Work/Play, uniform compensation, and club financial aid.

Financial Breakdown
Total Cost (no scholarship) / $1,100 - $1,500 Annually (depending on your team) / Circle Yes or No
Work/Play Program: Referee (age 12+ only) / -$500 / Opting In?
Yes No
Uniform (Check box if a new uniform is needed) / -$105 (game uniform only) / Opting In?
Yes No
Club Financial Aid (20%-80% of registration costs) / (dependent on financial status)
Possible Amount Owed / $99 - $1,200

**If a child wants to referee, please go to coloradoreferees.com and register for a certification class. You are responsible for registering for referee classes. Once your child earns $500 of referee fees, they will begin receiving paymentdirectly for each game they officiate. If your child does not meet the $500 of referee fees, the difference will be added to your account balance.**

Additional financial assistance is available for tournament entry fees and travel expenses. This form can be found at

I, the undersigned, certify that the information I have provided is true to the best of my knowledge. I understand that by requesting a scholarship from SVFC that I will need to divulge information relating to my income and family responsibilities. I understand that if awarded a scholarship, I may be asked to volunteer up to 10 hours of my time per season to SVFC. I also understand that I will need to reapply each year in order to receive a scholarship.

Signature ______Date______

------

FOR OFFICE USE ONLY

Date Reviewed
% Approved
Work/Play Participant?
Uniform Assistance
Amount Owed