Date: ___________ Team Name: ________________________ Level:_____________

How much can you afford to pay on a monthly basis? ___________________________

Are you willing to volunteer your time to assist the club in exchange for financial

assistance? Yes ____ No _____

Do you have any skills that you feel would benefit the club, in exchange for financial

assistance: ______________________________________________________________

Please check which area/s you would like the club to assist you with and the total cost of

each area:

Registration Fees________ Coaching Fees _________ Uniforms_________

Player’s Name: ______________________________________ Birth Date: _________

Address: _______________________________________________________________

Phone Number/s: ________________________________________________________

Father’s Name: _____________________ Mother’s Name: _______________________

Occupation: _______________________ Occupation: ___________________________

Reason for scholarship request:

________________________________________________________________________

Parent/Guardian’s Signature: ________________________________________________

Mail back to: Scholarship Request, CUSC, PO Box. 30995, Chas, SC. 29417