Joe and Mary Bach Athletic Scholarship Endowment
North Carolina Community Foundation provides a limited number of registration fee scholarships to help children participate in Coastal United Soccer Association programs. Specifically, this scholarship program provides assistance to youths from low income families who are not currently being served by existing programs.
Player's First Name *
Your answer
Player's Last Name *
Your answer
Player's DOB *
MM
/
DD
/
YYYY
Yo *
Parent/Guardian First Name *
Your answer
Parent/Guardian Last Name *
Your answer
Address *
Please enter Full Address #,Street,City
Your answer
Phone Number *
Please enter area code and number (xxx)xxx-xxxx
Your answer
Email Address *
Your answer
Does your child qualify for free or reduced lunch? *
Is he/she eligible for Social Security Insurance (SSI) *
If Yes then we will need the Service # or Case #
Is your child or family recieving public assistance? *
Ever recieve a fee waiver from the NC Community Foundation? *
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.
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service