2017 Application for Assistance
Child's Name
Your answer
Age
Your answer
Sex
Required
Grade in School
Your answer
Sport
Your answer
Sports Organization
Your answer
Receive Food Stamps
*If you answer yes, you must submit food stamp verification to kaley@pagnozzicharities.org 2 weeks prior to sports registration deadline.
Required
List all Household Members / Ages / all Income for the past 30 days
Must submit proof of all income listed which may include pay stubs, welfare, child support, alimony, pensions, retirement, social security, etc. to kaley@pagnozzicharities.org 2 weeks prior to the sports registration deadline.
Your answer
Parent (guardian) Name
Your answer
Phone Number 1
Your answer
Phone Number 2
Your answer
Address / City / State / Zip
Your answer
Email Address
Your answer
Name of Child's School
Your answer
County of Residence
Your answer
Child's Racial and Ethnic Orientation (Optional)
Today's Date
MM
/
DD
/
YYYY
Have you already registered for the sport for which you are applying for assistance?
We recommend registering for the sport and letting the organization know that you have applied for our assistance. We need a copy of your sports registration form 2 weeks prior to the registration deadline.
Required
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