Brockport Soccer Club Scholarship Form
By completing this form, you are stating that the information provided above is correct and true. You are giving BSC permission to verify any and all information provided, for the purpose of discerning eligibility for assistance.

* Applicants are encourage to include any other personal and/or financial information which you believe may
be useful in the decision making process.

* Scholarships will be awarded based on the financial need of the applicant in conjunction with the total money
allocated for scholarships as determined by the Board.

* This completed application should be submitted no later than one week prior to the start of tryouts in order to be considered for a scholarship. The applicants will be notified when their application is received and the results of their application will be communicated to them no later than one week after tryouts have been completed.

* Upon submission, this application is sent to the president of the soccer club.

* The information in this application will be shared with no other person in the Club including other Board
members. Please be sure to complete this form in its entirety.

* If a partial scholarship is awarded, the balance of the remaining Membership Registration Fee MUST be
paid no later than September 15th. Failure to pay the balance of the Registration Fee by that
date will result in the withdrawal of the partial scholarship.

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Email *
Parent/Guardian Name(s) *
Parent/Guardian Phone Number *
Parent/Guardian Address *
Season
*
Player's Name(s) and Team(s) *
A brief description of why you are applying for a BSC Scholarship *
Check if your family qualifies for any of the following assistance programs:  NYS Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance for Needy Families, Aid for Dependent Children, Foster Care, Medicaid
Please add any other personal and/or financial information below which you believe may be useful in the decision making and scholarship allocation process.
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