Scholarship Application - AYSO Region 71

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Please fill out this form entirely. One form should be filled out for each child.

Email *

Child's Name *

Has child participated in Region 71 before? Yes or No, if yes, what year did they play. *

Player Birth Date *

YYYY

Parent/Guardian Full Name *

Parent/Guardian home phone number *

Parent/Guardian cell phone number *

Please tell us why your child should be considered for a scholarship. *

Is your family currently receiving government financial aid/support? Check all that apply. *

Medicaid

SNAP/WIC

Section 8 Housing

Other

Required

In lieu of a registration fee, I will be able to volunteer in these areas/ways: *

Coaching

Refereeing

Publicity

Set-up/Clean-up Headquarters on Saturdays

Team mom

Other

Required

Of the $220.00 registration fee, how much support do you need? *

Submit

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