Scholarship Application
Kickers SAY Soccer (KSS) does not want any child to be denied the privilege of playing soccer due to his/her financial circumstances.
We offer a limited number of scholarships for registration fees. Scholarships are offered taking into account the needs demonstrated
and the financial ability of KSS to fund scholarships. Scholarships are available based on financial need, not playing ability.
All scholarships awarded are partial scholarships. Each player is required to pay $30 up front.
The information contained on this form is considered private and will be handled in an administratively confidential manner. A new
application must be made each season.
Please complete this application and forward it to: Kickers Say Soccer  604 LeMay Drive  Evansville IN 47712
Player Information
Player Name: _______________________________________________________________________________ Birth date: ____________________
Grade Entering Fall 2015: _____ School Entering Fall 2015: ______________________________________
**If not an EVSC school, what school would player go to if attending an EVSC school? ___________________________________________
Player’s Primary Contact/Guardian: ________________________________________________________________ Relationship: _________________
Address: ___________________________________________________ City: _______________________________ State: _____ Zip Code: _______
Primary Phone: _____________________________________________ Alternate Phone: _________________________________________________
Email address _________________________________________________________________ League communicates primarily through email.
Please describe the circumstances that give rise to the need for a scholarship:
Please check if any of the following apply:
_____ Family income qualifies for earned income credit on latest federal tax return.
_____ Children eligible for free or reduced school lunch program.
_____ Family or child on other public assistance.
_____ No employed wage earner in household.
_____ Single parent household
_____ Parent currently serving in active duty military
Have you received scholarships in prior seasons from Kickers Say Soccer?
_____ Yes
If yes, season(s) received: __________________________________________________
_____ No
In return for receiving financial assistance, KSS encourages you to participate in organizational and team activities, which
may include assisting with camp sign-ins, field set up and maintenance, coaching, being a team parent, or filling other
volunteer positions.
While your ability to volunteer will not affect your eligibility for a scholarship, your offer of assistance would be appreciated:
_____ I would like to volunteer; please call with any opportunities to do so.
_____ I might be able to volunteer; please call with further details.
_____ I am unable to volunteer
The undersigned parent/guardian certifies all information in this application for scholarship is accurate and complete. I
acknowledge that misrepresentation may result in my child’s expulsion from Kickers Say Soccer and may subject me to civil
or criminal liability.
__________________________________________
Parent/guardian Signature
www.KickersSaySoccer.org
__________________________________
Date of Signature

registrar@KickersSaySoccer.org
Rev. 04/11