Inter Atlanta FC Blues Scholarship Application

The Inter Atlanta FC (IAFC) is proud to offer a financial aidprogram for soccer athletes who need financial assistance to play soccer withIAFC. This program is available to players in all programs; recreational, academy and select. The financial aid budget is limited, andfunds are distributed on a first-come, first-served basis.

Financial Aid is granted based on financial need only, and is not based on playing ability or team placement. Financial Aid is only used to pay club/playing fees. You will need to pay for your uniform, cleats, turf shoes andteam fees, which include tournaments and travel expenses for the coach. Your team manager will let you know the amount of the team fees.

Please return the completed application and supporting documentation to:

Inter Atlanta FC

Attn: Financial Aid Committee

PO Box 133126

Atlanta, GA 30333

Starting in Fall of 2013, financial aid awards will be for the full year’s registration amount for Select and Academy families. If you are a Recreational family applying for aid, you will need to apply EACH season.

Player’s Name:______

Player’s Address:______

Player Phone:______Player email:______

Parents’ names:______

Parents’ Address (if different from player):

______

Parent Work Phone:______Parent Cell Phone:______

Parent email:______

Parents’ Address (if different from player):

______

Parent Work Phone:______Parent Cell Phone:______

Parent email:______

Is this your first season at AYSA?______Age Level:______

Playing Level and Team:______

Family Size (number of adults and children):______

Expectations:

1) All select and academy players receiving Financial Aid must pay the $28.00 Georgia State Soccer Association (GSSA) registration fee in order to be placed on the roster. Players applying for Financial Aid after signing night must pay the fee before being placed on the roster. All recreation players receiving Financial Aid must pay the $10.00 Georgia State Soccer Association (GSSA) registration fee in order to be placed on a team.

2) Inter Atlanta FC offers “working Financial Aid.” Families receiving aid will be requiredto volunteer at the club as a part of the financial aid package. Unusualcircumstances will be evaluated on an individual basis, and exemptions grantedbased on Financial Aid Committee approval. It is our intention for every childwho wants to play soccer to be able to play, and at the same time secure thecontinued financial resources to do so.

Please check one or two of the boxes below:

? Referee

Administrative Support

?Fundraising

?Coaching

?Field Work

All Financial Aid requests and supporting documents will be kept strictlyconfidential. Information is for the sole purpose of helping the IAFC FinancialAid Committee determine financial aid eligibility, and will not be shared withanyone except the Financial Aid Committee and Registrars.In addition to the Financial Aid Application, please submit a photocopy of thefront page of the parent or guardian’s most recent Federal Income Tax return, W-2, and paycheck stub.

Please remember to white out any social security numbers on the copy of

your Tax Return

REQUIRED INCOME INFORMATION FOR APPLICANT AND SPOUSE

ANNUAL GROSS Salary/Wages: Applicant $______Spouse $______

ANNUAL GROSS Child Support: Applicant $______Spouse $______

ANNUAL GROSS Alimony: Applicant $ ______Spouse $______

ANNUAL GROSS State/Fed. Aid: Applicant $ ______Spouse $______

ANNUAL GROSS Food Stamps: Applicant $ ______Spouse $______

ANNUAL GROSS School Loans/Grants: Applicant $ ______Spouse $______

ANNUAL GROSS Other Income: Applicant $ ______Spouse $______

ANNUAL GROSS TOTAL INCOME: Applicant $______Spouse $______

Please include the amount you can afford to pay.______

______

REQUIRED DOCUMENTATION(Information must be current)

Please submit your completed application along with proof of income, including:

• A copy of the front page of your most recent Federal Income Tax return

form 1040 (showing Adjusted Gross Income only) or IRS Proof of Nonfiling.

(To receive proof of non-filing call 800-829-1040. Choose option #2 and

then #2 again)

• W-2 for most recent year

• Most recent paycheck stub

• To substantiate a change in employment status, additionally include your

two most recent paycheck stubs, unemployment check stubs, disability

statement, or Social Security statement, or a letter from your employer on

company letterhead stating your current pay rate.

• Government assistance verification (food stamps, foster care assistance,

etc.)

• Other assistance verification (child support, alimony, student loans and/or

grants

• For Child Care & Camp applications, a letter of denial from SRS is

Required

STATEMENT OF NEED / REQUEST (Please provide any additional information

you feel the committee should take into account when considering your

application for financial aid, i.e., change in employment, change in marital status,

substantial medical expenses, or other extenuating circumstances.)

______

______

______

PLEASE NOTE: YOURAPPLICATION MUST BE COMPLETE IN ORDER TO BE CONSIDERED.

I certify and affirm the above information is true and complete to the best of myknowledge. I agree to inform the Inter Atlanta FC of anychange in my income, family size, or ability to pay. I understand incompleteinformation could jeopardize eligibility for financial assistance. I have read theProgram Description and understand there is no guarantee of fee assistance. Iunderstand the Inter Atlanta FC, its officers, directors,commissioners, coordinators, select coaches, club coaches, and volunteersmake no promise or assurances of financial aid. I understand the award amountis subject to funds available and the family’s ability to pay and is NOT based onplaying ability.

Signed:______Date:______