Download Application for Mercer Island Girls Basketball Booster Club

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