Football Club Ripley

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Request for Financial Assistance

* Please Enter Players First and Last Name:

* Please enter players Date of Birth:

Please enter your physical address:

* Please enter your Team Name/Coach:

* Scholarship Amount Requested:

If Partial, please describe below - the amount needed:

The following requested information will only be used by the FCR Scholarship/Financial Aid Committee to determine player eligibility for needs-based financial assistance.

1.Attach a paragraph explaining why you are requesting assistance

AND

2. How many FCR players _____ are in your household.

Please use this space answer the request above - why you are requesting assistance:

I certify that the information provided is true, complete and accurate. I realize that financial assistance to a player/family may be terminated if the financial situation is resolved, funds become unavailable, or if the player/ parent is deemed in conflict with the Club/Team requirements for player / parent commitment or behavior. I realize that financial assistance is not guaranteed for subsequent seasons.

Please Sign/Print and date in the next field - that you are certifying the information above.

* Please print/date your name:

* Relationship to player:

* Please add your phone number/email - the best way to contact you:

* indicates required fields

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Request for Financial Assistance