South Central Premier (Scp)

SOUTH CENTRAL PREMIER (SCP)

Application for Financial Aid

Please fill out all requested information on the Application completely and return the form to Andrea Duffy, President of South Central Premier, 417 Thoreau Street, Branford, CT 06405 by July 15, 2017. Decisions will be made by August 8,2017. ALL ITEMS MUST BE COMPLETED FOR THE CLUB TO CONSIDER THE APPLICATION.

Date of Application ______

Team Boys / Girls, Age Group ______# of years with SCP______

Player’s Name ______

LastFirst

Home Address ______

Street

______

CityState Zip Code

Home Phone #______Date of Birth ______

E-mail ______

Player resides with (check one) _____ Both Parents _____ Father _____ Mother ____ Guardian

Father/Guardian’s Name ______

LastFirst

Home Address (If different than above) ______

Home Phone #______Social Security # ______

Employer ______Employer’s Phone #______

Employer’s Address ______

Street and/or P.O. Box CityState Zip Code

Mother/Guardian’s Name ______

LastFirst

Home Address (If different than above)______

Home Phone #______Social Security # ______

Employer ______Employer’s Phone #______

Employer’s Address ______

Street and/or P.O. Box CityState Zip Code

SOUTH CENTRAL PREMIER

Application for Financial Aid (Page 2)

FINANCIAL INFORMATION:(all lines must be completed for consideration)

Total Family Annual Income (current year)$______

(explain any large differences between the current year incomeAnd annual income reported on the tax return submitted) (include information for both parents)

Fair Market Value of Family Home $______

Mortgage Balance on Family Home$______

Total Family Assets (including cars, stocks, bonds & real estate)$______

Total Family Debts (including mortgages, pers. loans, car, leases, etc.)$______

FINANCIAL AID REQUESTED: (all lines must be completed for consideration)

Example

Current Player Fee$2,100 (2006 team fee)$______

Minus :

Amount Applicant Proposing to Pay.$1,000 (parent contribution)

SCP expects some player contribution. $______

Grant Amount Requested$1,100(grant requested)$ ______

Note: A complete copy of your most recent Federal Income Tax Return must accompany this Application for Financial Aid. Applications will be returned if they are received without all pages of your return. Families who own a business must also include the tax return or some kind of financial information regarding the business. Additionally, separated parents who file separate tax returns need to include copies of both parents' return.

Financial aid is ONLY for the player fees. SCP does not provide financial assistance for travel fees, uniform fee or any individual team additional expenses.

IF YOU HAVE AN OUT STANDING BALANCE FROM PRIOR THE SEASON YOUR APPLICATION WILL NOT BE CONSIDERED.

All financial aid applications MUST be accompanied by $50 deposit. The $50 will be credited to the player fees.

Please use reverse side or additional pages to provide or explanations to support your request for Financial Aid.

I/We declare that the information reported on this form, to the best of our knowledge and belief is true, correct and complete.

______

Signature of Parent/Guardian Date Signature of Parent/Guardian Date