TYLER FREDERES MEMORIAL FUND

Midwest Awards Program Application

The Tyler Frederes Memorial Fund was established in 2014. Tyler was tragically killed in a single car accident on August 17, 2013 while visiting family in Kansas City. Tyler played ice hockey for 16 years and was passionate about the game. He lived a full life in his short 22 years, and we want to honor him, salute his love of the game and assist players 6 – 18 years old in the Midwest Amateur Hockey Association who have the same passion regardless of their financial situation.

2015-2016 Season Financial Assistance

Assistance from the Tyler Frederes Memorial Fund (TFMF) is based on both financial need and player character. To have your application considered by the TFMF Board, please complete all sections of the attached application.

Completed applications must be emailed to Midwest Amateur Hockey Association Vice President Chris Schmale @

Subject line should read:

MWAHA/Tyler Frederes Memorial Fund Assistance Program

Please have applications turned in by July 31st 2015.

It is the responsibility of the applicant to ensure MWAHA has received this packet. All applicants to this program are required to fill out the entire application as incomplete forms will not be accepted or considered. AssistanceProgram awardees will be notified by phone. Only one application per family.

Part 1: Player Information

All information submitted is confidential and will not be released to anyone other than the TFMF Assistance Program Committee.

Name of Player: ______

League Registering: ______

Address: ______

Street: ______

City: ______Zip Code: ______

Parent/Guardian: ______

Contact Phone Numbers:

Home: ______Work: ______Cell:______

E-mail address: ______

Number of years played hockey: ______

Number of occupants in household: ______

Number of household occupants participating in MWAHA: ______

Number of household occupants participating in hockey: ______

With what Association/s? ______

Academics:

School/Grade: ______

GPA (if applicable): ______

School Extracurricular Activities: ______
Other Activities (including community volunteer service): ______

______

Character:

Players, please attach a 1-page essay on why you qualify and deserve assistance from the TFMF. Coaches will also need to attach a referral letter.

Part 2: Financial Need

The TFMF Assistance Program is based, in part, on need. In the space below, please explain any circumstances the TFMF Assistance Program Committee should consider regarding your application.

______

I hereby state all the supplied information is true and correct. The assistance is for one season, and is not renewable.

Signature: ______

Parent/Guardian

Date: ______

Signature: ______

Player

Date: