Individual Application for Scholarship

Childs Name:*
First Last
Date of Birth*
Date Format: MM slash DD slash YYYY
Address*
Street Address City State ZIP Code
Parent / Legal Guardian*
First Last
Address if Different From Player
Street Address City State ZIP Code
Phone Number:*
Email Address:*
Current Team:
(Note: If you are currently not part of a team, please enter “NA”)
League:
(Note: If you are currently not part of a league, please enter “NA”)
Coach's Name:
Coach's Phone:
STATEMENT OF UNDERSTANDING
Please read and check off each statement and initial at the bottom that you understand.
- I understand that Bo Jackson’s Give Me A Chance Foundation is a nonprofit organization and that financial assistance is made possible through the generosity of donors and members.
- I understand that to maintain my sponsorship, I will need to provide updated documentation when requested by the Foundation, and I will be afforded at least 30 days to provide information when requested. Failure to do so may lead to revoking my sponsorship.
- I understand that to maintain my Foundation sponsorship, I will need to provide an updated application and income verification, and I will be afforded at least 15 days to provide this documentation. Failure to do so will lead to having my sponsorship revoked.
- I understand that I must submit requested documentation listed in Section 3 in order for my application to be reviewed
- I agree to notify the Foundation if my financial situation improves, so that my sponsorship can be re-evaluated, thus providing more opportunities for others in need.
- I understand that sponsorships will be awarded on a first-come, first-served basis, subject to available funds and eligibility.
- I understand that I must provide the Foundation with contact information changes (address, phone, email) as they occur.
- We work side-by-side with our coaches and teammates to make sure that all players, regardless of age, income or background, have the opportunity to learn, grow and succeed in athletics and academics.
REQUESTED DOCUMENTATION
In order to provide financial assistance in a fair and consistent manner, the following relevant documents must be attached and included with your application: Your most recent 1040 federal income tax return (if you file “Married Filing Separately,” please provide both returns) AND Last two pay stubs/LES (military) or Social Security or disability statement (or copy of bank statements showing amount of automatic monthly deposit) OR Profit/Loss statement & business license, if self-employed AND Documentation of any Federal Assistance such as food stamps, rent subsidy or Aid to Dependent Children, AND Documentation of any State Assistance such as unemployment compensation NOTE: If you do not have any of the above documents required, you must submit a letter explaining your personal situation, as well as why you do not have documents. All personal information will be kept confidential and secure.
File
File
File
File
File
File
GENERAL INFORMATION
Your application will not be processed until all required documents are provided. After all documentation is received, please allow 30 days to process your application. A Director will determine financial assistance eligibility after thoroughly reviewing the application. You will be notified whether your application has been approved within fourteen days after the review is complete.

APPLICANT HOUSEHOLD INCOME INFORMATION
Parent/Legal Guardian Name:*
First Last
Relationship to Child:*
Date of Birth:*
Date Format: MM slash DD slash YYYY
Social Security Number:*
Home Address:*
Street Address City State ZIP Code
Email Address:*
Employer:*
Work Phone:*
Home Phone:*
Cell Phone:*
Employer Address:*
Street Address Address Line 2 City State ZIP Code
Marital Status:*
Spouse Name:*
First Last
Spouse Date of Birth*
Date Format: MM slash DD slash YYYY
Spouse Employer*
Work Phone:*
Employer Address:"*
Street Address Address Line 2 City State ZIP Code
Total number of persons dependent on income per income tax return:
Have you ever applied for Foundation financial assistance in the past?
- Yes
- No
My circumstances are temporary. I will need financial assistance until:
Date Format: MM slash DD slash YYYY
If Temporary, Please Explain

LIST ALL HOUSEHOLD MEMBERS
Gross Monthly Household Income:
Employment Parent:
Employment Spouse:
Child Supprt Parent:
Child Support Spouse:
Government Assistance Parent:
Government Assistance Spouse:
Retirement/Pension Parent:
Retirement/Pension Spouse:
Other Sources of Income Parent:
Other Sources of Income Spouse:
Total Household Income

MEDICAL RELEASE
In the event of a medical accident or other emergency that may arise while my child is participating as a member of a team, league, camp and/or clinic of Bo Jackson’s Give Me A Chance Foundation when a parent or guardian is unavailable, I hereby authorize a member of the Bo Jackson’s Give Me A Chance Foundation or Cangelosi Baseball staff to make such arrangements as they consider necessary for my child to receive medical or hospital care and transportation. Under such circumstances, I further authorize the physician named below to undertake such care and treatment of my child as he/she considers necessary. In the event the below-named physician named below to undertake such care and treatment of my child as he/she considers necessary. In the event that below-named physician is not available, I authorize such care/treatment be performed by any licensed physician or surgeon. The undersigned herby agrees to bear all costs incurred as a result of the foregoing.
Parent/Legal Guardian Signature:
First Last
Date
Date Format: MM slash DD slash YYYY
Relationship to Player:
Insurance Company:
Policy #:
Group #:
Physician:
Phone:
Emergency Contact Name:
First Last
Home Phone:
Cell Phone:

Individual Application for Scholarship

Please read the information and fill out electronic form below

Step 1 of 4

STATEMENT OF UNDERSTANDING

REQUESTED DOCUMENTATION

GENERAL INFORMATION

APPLICANT HOUSEHOLD INCOME INFORMATION

LIST ALL HOUSEHOLD MEMBERS

Gross Monthly Household Income:

MEDICAL RELEASE

GIVE ME A CHANCE FOUNDATION
1717 N. Naper Blvd., Suite 108
Naperville, IL 60563
P: 630.219.1582
F: 630.445.4015

Individual Application for Scholarship

Please read the information and fill out electronic form below

Step 1 of 4

STATEMENT OF UNDERSTANDING

REQUESTED DOCUMENTATION

GENERAL INFORMATION

APPLICANT HOUSEHOLD INCOME INFORMATION

LIST ALL HOUSEHOLD MEMBERS

Gross Monthly Household Income:

MEDICAL RELEASE

GIVE ME A CHANCE FOUNDATION 1717 N. Naper Blvd., Suite 108 Naperville, IL 60563 P: 630.219.1582 F: 630.445.4015

GIVE ME A CHANCE FOUNDATION
1717 N. Naper Blvd., Suite 108
Naperville, IL 60563
P: 630.219.1582
F: 630.445.4015