Tiana Tillman Cheer Hardship Program (Little Miracle)

This form is for those applying for financial assistance. Only a VERY LIMITED number of Scholarships are available.It is the intention of the Tiana Tillman Cheer Program is to make every effort to ensure our program is open to all interested members of the community. With this goal in mind, we have created a hardship application process for existing and prospective members with a special need or consideration for them to participate. Your application will be reviewed by the board and will be assessed based upon multiple criteria. Financial need alone is no guarantee of acceptance! We have a limited number of scholarships funds and we regret that we cannot assist everyone who applies for a hardship, but are making every effort to ensure as many Cheerleaders as possible have an opportunity to Cheer in organized football in Barstow Youth Football and Cheer.

Participants First Name: ______________________ Last Name: __________________________
Email: _______________________________ Phone Number: _______________________
School: _______________________________ Grade entering in fall:___________________
Birth Date: _____________________________
Parents First Name: ___________________________Last Name: __________________________
Daytime Phone Number: ________________________
Monthly Income: ______________________________
How many children in the household under 18:_________________________
How many years have you been a member of Barstow Youth Football?
____ New Applicant ____ 1 Year ____ 2 Years ____ 3 Years or more
How many times have you applied for a scholarship from Youth Football?
All scholarship recipients will be required to make partial program payment and/or secure some percentage of player sponsorships.
Half of $150 (You agree to pay ($75.00)
Are there additional extenuating circumstances or other information that we should consider in processing your request?
Are you willing or able to assist in anyway in administering club activities (organizing program
sponsorships, equipment handout, equipment turn in, assisting in the jamboree coordination, coordinating team parents, coordinating team volunteers, field setup and tear down, auction baskets, concessions, apparel distribution, etc.)?

Thank you for your interest.