Player Assistance Program Application

Michigan Fire Juniors

Player Assistance Program Application

Player Name: ______Age Birth Year: _____

Parents Name: ______Player Gender: M/F

Address: ______Level: Select/Premier/MRL/DA

______Player Gender: M / F

Home Phone: ______Cell: ______

Mother’s Email: ______Father’s Email: ______

Has this player received club assistance in the past? Y / N.

If yes, when and how much: ______

Have other players in your family received club assistance in the past? Y / N

If yes, please explain.... ______

How much assistance are you requesting for this season? ______

How many children in your family are playing for the Fire? ______

Have you or anyone in your family volunteered to help in our Soccer Club in the past? Y / N

If yes, please explain: ______

Other information that pertains to your request for financial assistance (recent hardship etc....) ______

Household Income Information:

What is your annual household income? ______(from all sources)
How many people live in the home? ______(more than 9 months / Year)

Does your family receive other financial assistance from:

Other sports organizations, list: ______

Church / Religious organizations, list: ______

Federal or State agencies, list: ______

Other sources, list: ______

Your application for assistance needs to be accompanied by a copy of your Federal 1040 tax return as verification of your income. No application will be considered without it. All information submitted, including the copy of your tax returns will be held in the strictest confidence and will be viewed by only the Player Assistance Program Committee when considering your application. Please black out any Social Security numbers.

If your application is approved, it is required that you serve 10 hours in a volunteer capacity to assist the Michigan Fire Juniors throughout the year (tryouts, concessions, field set up or tear down). This is not an option; it is an integral part of our assistance program. Please contact Nancy Hop for more information at .

I herby certify that all of the above information is true and correct. I understand that this information is being provided as a method to assist Michigan Fire Juniors board members in determining the level of financial assistance that may be awarded toward player fees for the ______Michigan Fire Juniors soccer season. I understand that monies provided through this application process will be used to pay Michigan Fire Juniors player fees, and will not pay for any supplemental expenses associated with participating in Michigan Fire Juniors, such as: travel expenses, team fees, uniform, etc. I authorize the representatives of Michigan Fire Juniors to discuss this request with the team manager/coach, along with board members in an effort to make a determination of what financial assistance may be granted and/or track payments against an established payment plan.

Printed name of person requesting Assistance Signature of person requesting Assistance AND date

Please email all forms to or mail to

Michigan Fire Juniors

PO Box 5

Hudsonville MI 49426