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Embed code for: EPSC - Financial aid request form - 2015 04 01
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Financial Aid Application Applicant (Player) Name: Team: Describe need for financial aid: Financial aid requested: $ _______ Requesting payment plan? No Yes ____ Bi-Monthly (SEP/NOV/JAN/MAR) ____ Monthly (SEP-APR) Parent/Guardian: Street: Email: Phone: City & Zip: Parent/Guardian: Street Email: Phone: City & Zip: Number of persons in household: Children: Adults: What was the adjusted gross income for last Less than $20,000 tax year or net household income for families $20,000 - $40,000 not filing a tax return? $40,000 - $60,000 Indicate assistance family receives Subsidized housing Food stamps Medical assistance If parents live apart and file tax forms separately, what is the combined adjusted and/or net income? $ Applicant’s school: If private school, do you receive financial assistance? If yes, please indicate amount: All applications must include documentation demonstrating proof of need. As stated in the EPSC Financial Aid Policy, proof of need is established through submission of the applicant’s family’s most recent Federal income tax return (complete with schedules). Additional documents that may be submitted to establish proof of need include current pay stubs for the applicant’s parents or guardians. All documentation must be submitted prior to the Due Date of the Program Fee(s) you are requesting assistance for (generally August 15 for teams forming after Summer tryouts – and February 15 for teams forming after Winter tryouts). Please submit complete application to: EPSC P.O. Box 44561 Eden Prairie, MN 55344 OR Email: FinancialAid@epsoccerclub.com Parent/Guardian Signature Date EPSC Office Use Only Date received: Approved By: Financial aid amount approved: $ Date reviewed: Updated April 2015