Coastal United Scholarship Fund

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The Coastal United Scholarship Fund was created to help support Coastal United Soccer Association players that are in need of registration fees, uniforms, and cleats. To qualify for the scholarship families must be in a public assistance program or have a demonstrated need for funds.

Player's DOB *

YYYY

Player's First Name *

Player's Last Name *

Player's Gender *

Male

Female

Address *

Please enter Full Address #,Street,City

Parent/Guardian First Name *

Email Address *

Parent/Guardian Last Name *

Phone Number *

Please enter area code and number (xxx)xxx-xxxx

Does your child qualify for free or reduced lunch? *

Yes

Is he/she eligible for Social Security Insurance (SSI) *

If Yes then we will need the Service # or Case #

Yes

Is your child or family recieving public assistance? *

Yes

Ever recieve a fee waiver from the NC Community Foundation? *

Yes

Demonstrated Need

If you are not participating in any of the above programs but feel that you have a demonstraded need for scholarship funds please describe below.

Requesting Funds *

Please select (if available) what you would like to recieve from the scholarship Fund.

Registration Fees

Uniform Kit

Cleats

Required

CONSENT TO EXCHANGE INFORMATION

By submitting this form, I am allowing various agencies to exchange certain information to certify that all the information I have supplied is true and correct. I permit the NC Community Foundation, Bach Endowment and Coastal United Soccer Association staff to verify the information on this application. I understand that my youth's participation in the Soccer Program requires a commitment to attend a minimum of 80% of the scheduled practices and games

REQUEST FOR FEE WAIVER

I am currently in a public assistance program such as Free or Reduced Lunch, Food Stamps, Foster Care, Medicaid, or SSI. I request a fee waiver from NCCF Joe and Mary Bach Athletic Scholarship Endowment program and give permission for the Department of Social Services to release information verifying my eligibility. I understand that if I am receiving Medicaid of SSI, I must submit proof that I am receiving services.

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