Recreational Programs Financial Aid Application

Personal Information

Player Name *

First

Last

Birth Year *

Number of seasons played with BUSC *

Number of siblings in the club *

Please note the total number of siblings in the club (not including the player you are registering). For example, if this is the only player then the answer would be 0.

Parent/Guardian Information

Parent/Guardian Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Email *

Parent/Guardian 2 Information

Parent/Guardian Name 2

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Email

Financial Information

All financial information provided below must reflect the combined earnings and/or reported income of all legal guardians of the scholarship applicant.

Do you own or rent your home? *

Own
Rent

Tax Document Required *

Yes, I understand

Copy of most recent filing must be provided as part of this application. If you did not file taxes, we will need your W2 or your pay stub.

Tax filing joint or individual? *

Joint
Individual

Tax Year *

Federally reported Adjusted Gross Income *

From IRS Form 1040 line 35; 1040EZ line4; Telefile line 1. If you did not file taxes, please provide your MONTHLY or YEARLY pay and provide the documentation via a W2 or pay stub.

Total earnings in previous year *

You must report your total earnings regardless of whether you filed a tax return. This information may be on your W-2 form, 1099 form, or on IRS Form 1040-lines 7, 12, and 18, 1040A Line 7, or 10140 EZ line 1. Telefilers should use their W-2s.

Additional Information

Additional Considerations

Please provide any additional considerations or extenuating situations that should be part of the evaluation of this player’s application for a scholarship.

Final Submission

I acknowledge that the following criteria and rules are applicable to players seeking to apply for a BUSC scholarship: Must be registered with BUSC and participating in a BUSC Competitive program (MLS Elite,YDP, Premier, Elite, or Select) Must be a player in good standing with BUSC Must submit a scholarship application and provide the most recent Federal Income Tax filings or proof of earnings to the club BY THE APPLICATION DUE DATE. Scholarship funds are applied as a credit by the club towards club fees only. Team fees, registration, or uniform costs are not eligible for scholarship. I am responsible for making all other payments to the team or club on the payment schedule established by the club. Should I fail to make the required payment, they player’s playing pass shall be revoked until required payments and/or arrears are made to the club. I declare that the information herein is true and correct. By typing or signing my name below, I attest that my statements within this application form are true and valid to the best of my knowledge and belief. Your application submission will not be complete until your tax forms are mailed in. Please mail your Tax forms are to: BUSC Scholarship 275 Rose Avenue, Ste. 209 , Pleasanton CA. 94566

Today's Date *

Initials *

PLEASANTON BALLISTIC UNITED SOCCER CLUB

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