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Application for Mercer Island Girls Basketball Booster Club Scholarship Program Description: MIGBBC offers an assistance program for Mercer Island girls who are in need of financial aid in order to play basketball. Each request is considered on a per season basis. This request may cover registration, uniform, trainer, and travel fees (if applicable). The amount of aid and number of girls receiving aid is dependent upon available funds and is not guaranteed from year to year. Confidentiality: All information is for the sole purpose of helping MIGBBC Scholarship committee make grants. Scholarship requests are strictly confidential. Incomplete forms will not be considered and may be returned. Program/Area requesting assistance for ___________________________________________________ Player’s Basketball Goals: _______________________________________________________________ _____________________________________________________________________________________ Player’s Name: ________________________________________________________________________ Address: _____________________________________________________________________________ City: _________________________________________________________ Zip Code: ______________ Player’s Date of Birth: _________________________________ Player’s Grade at School: ___________ Person completing form: ________________________________________________________________ Relationship to player: __________________________________________________________________ Home Phone: _____________________________ E-Mail: ____________________________________ Other Phone (work/cell): ______________________________________ Qualify for free or reduced lunch program? _________________________________________________ Estimated Current Year Family Income: ____________________________________________________ Family size: ____________ Reason for requesting aid: _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ MIGBBC SCHOLARSHIP APPLICATION Financial Aid Requested: Cost of Program Cost of Uniform/Equipment $_____________________________________ $_____________________________________ Other Costs: _____________________ $______________________________________ _____________________ $______________________________________ TOTAL: $______________________________________ Amount you can Pay: $______________________________________ Amount of Aid Requested: $______________________________________ I certify that to the best of my knowledge the above information is true and accurate. Parent Signature: _________________________________________________ Date: _______________ Print Name: _____________________________________________________ PLEASE RETURN THE COMPLETED FROM IN A SEALED ENVELOPE MARKED “ATTENTION: MIGBBC SCHOLARSHIP”, PO BOX 1036, MERCER ISLAND, WA 98040. DO NOT WRITE IN THIS SPACE FOR SCHOLARSHIP COMMITTEE USE ONLY Request decision: APPROVED or DENIED Amount of Request: $________________________ Amount Approved: $________________________ Family Contribution: $_________________________ ________________________________________________ ________________________________ MIGBBC President Date