Application Form – Horizons Youth Sports Academy

ATHLETE INFORMATION

Athlete's Name(Required)

First Last

Birthdate(Required)

Gender(Required)

Male

Female

Address(Required)

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

Amount of Scholarship Requested:(Required)

Full

Partial

Amount paid at registration:(Required)

Has athlete received scholarship from the HYSA in the past calendar year?(Required)

Yes

No

Amount:(Required)

Desired Sport:(Required)

Basketball

Flag Football

Lacrosse

Soccer

Volleyball

Program(Required)

Travel

Recreation

PARENT / GUARDIAN INFORMATION

Parent/Guardian Information:(Required)

First Last

Email(Required)

Address(Required)

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

Cell Phone(Required)

Home Phone

Athlete lives with:(Required)

Both Parents

Mother

Father

Other

Income

Total Household Annual Income:(Required)

Does your child qualify for free or reduced school lunch?(Required)

Yes

No

To complete this form, you must upload required proof of income) of the following attachments:

One Month of current consecutive pay stubs (4 weekly, 3 bi‐weekly, or 2 bi‐monthly paystubs).
Printout from Social Security Administration.
Most recent completed tax return. Notarized letter stating that applicant has no income.

Proof of Income

Max. file size: 20 MB.

To complete this form, you must upload one or more of the following attachments:

Written/Request from Parent/Guardian (*Required)
Documentation showing receipt of assistance such as Food Stamps, Medicaid, SSI, Foster Care, WIC, etc.
Written recommendation by school representatives, social services representatives, family, or friend of the family.
Documentation demonstrating an immediate financial hardship.

Attachments

Drop files here or

Accepted file types: jpg, gif, png, pdf, doc, docx, Max. file size: 30 MB.

Signature

Scholarship Application Deadlines

All financial aid requests must be submitted a minimum of 2 weeks (14 days) prior to the start of the season in which the player is interested in enrolling.

CONSENT TO RELEASE INFORMATION

I understand that my signature authorizes the Horizons Youth Sports Academy to obtain verification of all information on this application and that additional information may be necessary for approval of this application.
I certify that all of the information I have supplied is true and correct.
I understand that this application does not guarantee an opening or acceptance into the sport/league desired, or a scholarship award.
I understand that my child’s participation in the scholarship program requires a commitment to attend the scheduled practices and games as outlined.
I understand that participation by an adult family member in at least eight (8) hours of voluntary service as outlined is required for participation in the scholarship program.

Parent/Guardian Printed Name(Required)

First Last

Type your full name to sign the form(Required)

Date

Comments

This field is for validation purposes and should be left unchanged.