Student Athlete Consortium Assistance Application

Note: Assistance is contingent upon meeting the prerequisites and available funds. Submission of application does not guarantee assistance. Community and organization donations are essential to funding applications.

APPLICATION PREREQUISITE*

- Student Athlete plays a sport in a competitive league

- Student Athlete is currently active in a competitive sport

- Student Athlete has a GPA of 3.0 or greater

- Student Athlete has 10 or more community outreach hours

STUDENT ATHLETE'S NAME*

AGE*

Age of Student Athlete

NAME OF SCHOOL*

School of Attendance

GPA*

Current Grade Point Average

COMMUNITY OUTREACH HOURS*

Volunteer hours for the current year

NAME OF COMPETITIVE ORG/LEAGUE*

Student - Ethnicity (Optional) Demographic Info

Hispanic or Latino

Not Hispanic or Latino

Not to Disclose

PARENT/GUARDIAN NAME (First and Last)*

CONTACT EMAIL*

CONTACT PHONE NUMBER*

Phone

PARENT/GUARDIAN ADDRESS*

DESCRIPTION OF NEED*

REQUEST AMOUNT*

ORGANIZATION/LEAGUE CONTACT*

Payment will be made payable or directly to the sport organization.

PAYEE INFORMATION*

Provide organizations account name for either one of these methods: Check, Venmo, PayPal.

PAYMENT METHOD*

Provide organizations preffered payment method.

Venmo

PayPal

Check

PAYEE ADDRESS*

Language - (Optional) Demographic Info

English

Spanish

Other

Not to Disclose

Deidentified Data*

It is the request of the Student Athlete Consortium that the demographic information be proved as the data will be consolidated and deidentified. The deidentified data will be utilized in the application of grants for funding. Providing demographic information is confidential and optional. All information will be deidentified. Deidentified information is the process used to prevent someone's personal identity from being revealed.

The information provided is true and accurate.

Electronic Signature

Send me a copy of my responses

Privacy Notice|Report Abuse