Salt City Soccer Club - Scholarship Application Form

PERSONAL INFORMATION

NAME:   

S.S.#:

DATE OF BIRTH:

MALE:  [      ]        FEMALE:  [      ] 

ADDRESS:

TELEPHONE:

EMAIL:

CURRENT SALT CITY CLUB TEAM: 

COACH'S NAME: 

NUMBER OF YEARS PLAYING FOR SALT CITY:

PARENT/GUARDIAN:

OCCUPATION:

ADDRESS (if different than above):

SCHOLASTIC INFORMATION

HIGH SCHOOL ATTENDED: 

ADDRESS: 

PHONE:

ESTIMATED DATE OF GRADUATION:

SCHOLASTIC AVERAGE JUNIOR YEAR:

SCHOLASTIC AVERAGE SENIOR YEAR (First Semester):

DID YOU PARTICIPATE IN HIGH SCHOOL SOCCER?  Junior Varsity:  [      ]  Varsity:  [      ]

COLLEGE INFORMATION

COLLEGE YOU PLAN TO ATTEND:

CITY:                                             STATE:

PLANNED MAJOR:

LIST ANY EXTRACURRICULAR IN WHICH YOU PARTICIPATE

 (As well as any leadership roles you may have within these activities):

Describe a way in which playing soccer for Salt City has had a positive impact on your life:

GENERAL INFORMATION

Please attach any letters of recommendation by teachers, coaches, employers, etc. which help to describe you as a person and as a valuable member of the community.

The information that I have reported herein is true, correct and complete.  I authorize the use of the information on this form by the Salt City Soccer Club selection committee.

Applicant's Signature:

Parent/Guardian Signature:

Date: