Individual Application for Scholarship
  1. SECTION 1: PARTICIPANT INFORMATION

    The asterisk(*) indicates information is required to submit this form. After submission you will receive a confirmation and full copy for you to save for your records. Please be as detailed as possible and be sure to fill in every field. If you do not know the answer or need to gather the information and fax or mail please indicate that in the message box at the end of this form. Please send any supplemental information to: Give Me A Chance Foundation, 612 Territorial Drive, Suite B, Bolingbrook, IL 60440 or fax to: 630.378.5370
  2. Name of Child
    Please type your full name.
  3. Date of Birth
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  4. Complete Address
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  5. Address (if different from player):
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  6. Current Team
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  7. League
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  8.   (Note: If you are currently not part of a team or league, please enter “NA”)
  9. Coach Name
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  10. E-mail
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  11. SECTION 2: STATEMENT OF UNDERSTANDING

  12. Please read and check off each statement and initial at the bottom that you understand.
  13. 1
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  14. 2
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  15. 3
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  16. 4
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  17. 5
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  18. 6
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  19. 7
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  20. 8
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  21. —————————————————————————————
  22. SECTION 3: REQUESTED DOCUMENTATION

  23. In order to provide financial assistance in a fair and consistent manner, the following relevant documents must be attached and included with your application:

    1. Your most recent 1040 federal income tax return (if you file “Married Filing Separately,” please provide both returns) AND
    2. Last two pay stubs/LES (military) or Social Security or disability statement (or copy of bank statements showing amount of automatic monthly deposit) OR
    3. Profit/Loss statement & business license, if self-employed AND
    4. Documentation of any Federal Assistance such as food stamps, rent subsidy or Aid to Dependent Children, AND
    5. 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.

  24. File Upload
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  25. File Upload
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  26. File Upload
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  27. File Upload
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  28. File Upload
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  29. File Upload
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  30. —————————————————————————————
  31.  
  1. SECTION 4: 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.
  2. SECTION 5: APPLICANT HOUSEHOLD INCOME INFORMATION

  3. Date of Birth
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  4. Social Security Number
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  5. Guardian Complete Address
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  6. Email Address
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  7. Your Employer
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  8. Employer Information
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  9. Marital Status
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  10. Spouse Employer
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  11. Employer Address
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  12. Total number of persons dependent on income per income tax return
  13. #
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  14. My circumstances are temporary. I will need financial assistance until
  15. Date
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  16. Explanation
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  17. —————————————————————————————
  18. Gross Monthly Household Income
  19. Employment(*)
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  20. Employment Spouse
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  21. Child Support
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  22. Child Support Spouse
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  23. Retirement/Pension
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  24. Retirement/Pension Spouse
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  25. Other Sources of Income
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  26. Other Sources of Income Spouse
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  27. —————————————————————————————
  28. Total Household Income
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  29.  
  1. SECTION 6: CERTIFICATION OF INFORMATION

    I certify that all information on my application is true and complete to the best of my knowledge and any misrepresentations may result in automatic sponsorship termination and suspension from making future applications. I further understand that I am applying for a financial assistance sponsorship and that the subsidy will expire on May 31, 2013. Failure to provide updated income documentation when requested will result in the termination of Foundation sponsorship.
  2. —————————————————————————————
  3. SECTION 7: 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.
  4. Today's date
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  5. Relationship to Player
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  6. Insurance Company
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  7. Policy #
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  8. Group#
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  9. Physician
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  10. Physician Phone
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  11. Emergency Contact Name
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  12. Contact Phone
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  13. —————————————————————————————
  14. Submit

    The asterisk(*) indicates information is required to submit this form. After submission you will receive a confirmation and full copy for you to save for your records. Please be as detailed as possible and be sure to fill in every field. If you do not know the answer or need to gather the information and fax or mail please indicate that in the message box below. Please send any supplemental information to: Give Me A Chance Foundation, 612 Territorial Drive, Suite B, Bolingbrook, IL 60440 or fax to: 630.378.5370
  15. Message
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  16.   

Bo would like to thank our many sponsors - Please support them as they support us

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Newsletter

Important Forms

Contact GMACF

Give Me A Chance Foundation
612 Territorial Drive, Suite B
Bolingbrook, IL 60440
ph: 630.759.0518
fax: 630.378.5370

Bo Jackson Inquiries

Any inquiries not Foundation related: Appearance, Endorsement, etc.

Please contact
Becky Daniel
email rydaniel@comcast.net
(251) 471-0008