Athletics « Girls Place: After School, Sports and Summer Camp Programs for Girls in Gainesville

1. In accordance with policy #5 of Girls Place, Inc., eligible members must be a resident of Alachua County to receive assistance

2. Each application MUST be accompanied by a 1040 form from the most previous tax year AND a free/reduced lunch form from the school the child attends. APPLICATIONS WILL NOT BE CONSIDERED WITHOUT THESE FORMS BEING SENT TO THE GIRLS PLACE OFFICE BY the first day of practice/ clinic. . You may bring the appropriate forms to the Girls Place office personally, or a copy may be faxed to (352) 373-5550.

3. Need will be assessed by administrative staff based upon the responses to the questionnaire below.

4. An application will not be considered without EVERY question being answered and the registration form submitted prior.

Financial Assistance Details

1. Receipt of assistance does not entitle a member to full assistance. In most cases, when assistance is granted, parents will be responsible for some of the fees for the program.

2. The administrative staff and the economic status of Girls Place shall determine the amount of members assisted and the level of assistance.

3. Financial assistance is good for one season only. If you are granted any assistance, it WILL NOT roll over to the next program your child participates in.

Personal

Which sports program are you applying for assistance? (Please select one only. If assistance is needed in multiple programs, please fill out an application for each program).*

Parent Name*

First and Last Name

First Child's Name *

Date of Birth*

mm/dd/yyyy

Grade and School*

Second Child's Name (if applicable)

Date of Birth

mm/dd/yyyy

Grade and School

Third Child's Name (if applicable)

Date of Birth

mm/dd/yyyy

Grade and School

Residence

Local Address*

Street Address, Apt #, City, State, Postal Zip Code

Home Phone Number

Cell Phone Number

Fax Number

Email Address - Must be checked regularly.*

Number of adults living at above residence:

Number of children living at above residence:

Do any of the above residents have special needs?

Yes
No

If yes, please describe:

Finances

Amount of combined annual income for all adults at the above residence: *

Does your child qualify for the FREE lunch program at school?*

Yes
No

Does your child qualify for the REDUCED lunch program at school?*

Yes
No

Describe any federal, state, or local assistance the family is currently receiving (i.e. Food Stamps, Medicaid, Early Learning Coalition, etc.):

In addition, please write a brief statement describing why you feel your family is in need of financial assistance for one of our programs. Be sure to include a description of any financial constraints above and beyond the eligibility requirements. *

By typing my full name below, I hereby agree to abide by the rules and regulations of Girls Place, Inc., as they relate to my application for financial aid: *

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