FINANCIAL ASSISTANCE APPLICATION APPLICATION DEADLINES: Fall Competitive: June 9, 2017 | Fall Recreational: August 4, 2017 High School Boys – Summer: August 4, 2017 | Late Fall: November 15, 2017 Spring Recreational: March 17, 2018 All information must be completed in order to be considered for assistance from the Colorado Rapids Youth Soccer Club. Appropriate application fees must be paid at time of registration. We’re sorry, grant requests will not be considered if there is an outstanding balance on the family’s account.

Player Information Last Name:

First Name:

Street Address:

City:

Email Address:

Phone Number:

Age Group:

Team Name:

Zip Code:

Parent/Guardian Information Parent/Guardian #1:

Parent/Guardian #2:

Marital Status:

Number of Dependents:

Program Level and Application Fee (check one):

Recreational $50

Adults

Children

Competitive $100

Financial Information Itemized Yearly Income Parent/Guardian #1: Parent/Guardian #2: Alimony: Child Support: Other Income: (Social Security, Food Stamps, Unemployment, Disability, Pension) Total Income: You MUST provide two (2) of the following documents with your application: • Federal tax return • One other form of documentation of income such as last 2 consecutive pay stubs for each wage earner, Social Security Annual Benefits Statement or Unemployment Benefits Statement • If you receive child support, food stamps, Department of Social Services financial assistance or other assistance, please provide documentation of this assistance as well. • Please list any special circumstances that may contribute to your request for financial assistance on separate sheet and attach to this form. Incomplete applications will NOT be processed or considered. You must submit the application fee with this form. I certify that the above information is accurate and truthful.

Signature Date COLORADO RAPIDS YOUTH SOCCER CLUB l 1001 S. Monaco Parkway #210, Denver, CO 80224 l 303.399.5858 l www.rapidsyouthsoccer.org

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