AZ NICA Financial Assistance Application
We are committed to making our program accessible to everyone, regardless of their financial situation.  Therefore, limited financial assistance is available for AZ NICA Membership Fees between 10/15/23-01/01/24. Any financial assistance issued by AZ NICA will be in the form of a credit to be applied during the time of registration in the Pit Zone. 

Financial assistance will be provided based on the following criteria:
1) Demonstrated financial need
2) Commitment to team and league participation between 11/1/23 and 4/6/24
3) Community volunteer experience
4) AZ NICA funds availability

Questions about this application or the scholarship process can be directed to League Director: Jen Harrelson at
Sign in to Google to save your progress. Learn more
Email *
Applicants Name (Student or Coach) *
Applicant Grade *
Parent / Legal Guardian Name
Parent Phone Number: *
Parent Email Address *
Team Affiliation *
Did you participate with AZ NICA last season? *
Which fees are you requesting a scholarship for? *
Annual household income? *
100% financial assistance is limited to extreme situations. Please indicate what portion of the fees you are able to pay. Due to the limited nature of our scholarship funds and in the interest of fairness to all scholarship applicants, we ask that all participants pay for their participation to the best of their ability. *
In the space below, please describe the community volunteer activities you participated in over the past 12 months. These activities should be for the applicant (student-athlete or coach) and do not have to be limited to AZ NICA activities/events.     *
Financial Assistance Agreement: Due to the limited amount of funds, we would like to ensure that the those who receive financial assistance agree the following: *
Clear form
Never submit passwords through Google Forms.
This form was created inside of National Interscholastic Cycling Association. Report Abuse