Student-Athlete Sports Subsidy

Student Information

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email

Phone

Grade

Gender

Date of Birth: 18 and under

High School / École

School Address / Adresse

Number Street / Rue City / Ville Province / Province Postal Code / Code Postal Country

School Phone Number

For what sport(s) are you applying for funding?

Do you compete in this sport(s) outside of school?

How many courses are you registered for in this semester/year?

If approved for financial assistance, I will (the student) work with the school to fulfill my commitments as a student (ie: Be on time and regularly attend class, complete assignments, work toward community service hours etc.)

PARENT INFORMATION – only to be completed by parent/guardian

Parents Name

First Last

For your son/daughter to participate in school sport, please outline the financial barriers that the family is facing.

ENDORSEMENT REQUIRED

The Endorser acts as an objective third party who is familiar with the applicant and his/her family, is in a position to identify the financial barriers restricting the student’s participation in high school sport as outlined by the parent or guardian on Page 1, and is fully aware of the uses of the funds charged to the student.

The Endorser MUST be one of the following (check one):

Name of Endorser

First Last

Endorser Email