<p>EASTON YOUTH HOCKEY ASSOCIATION</p><p>Financial Hardship/Scholarship Program The Financial Hardship/Scholarship Program is designed to provide hockey exposure to young players who otherwise may not have the opportunity to play the game. The program is comprised of grant money from the Columbus Blue Jackets Foundation. Financial assistance will be granted on a per season basis. Applicants must reapply each season to be considered for financial assistance.</p><p>Application Guidelines: 1. The applicant must be in good financial standing with EYHA and exhibit a general financial need. 2. All applicants must be registered with EYHA for the current season as a Mini- Mite, Mite, Squirt, Peewee or Bantam player. 3. An application for a financial assistance must be submitted after player(s) registration has been completed and before the application deadline August 31st of the current hockey season. 4. Application must be accompanied by one of the following documents: a. Copy of parent(s) or guardian(s) current year 1040EZ, 1040, or 1040A U.S. IRS tax form. 5. Program is limited to financial aid for house league fees only. 6. A limited number of scholarships are available on an annual basis. Application Process: 1. Application must be received by August 31st with the noted necessary paperwork to the following address: EYHA Treasurer PO Box 30381 Gahanna OH 43230 2. The Financial Assistance Committee, which consists of the EYHA President, President Elect and Treasurer will review all applications. 3. Financial assistance will be granted based on eligibility, the total number of applicants, the amount of available funds, and other factors considered relevant by the committee. 4. The Financial Assistance Committee reserves the right to request additional information. 5. Applicant’s names and all information provided will be kept strictly confidential. Only the Financial Assistance Committee will review the applications.</p><p>Amended June 2013 EASTON YOUTH HOCKEY ASSOCIATION Contact EYHA Treasurer at [email protected] if you have any questions.</p><p>One application per family.</p><p>Player(s) Name & Division ______- ______</p><p>______</p><p>Street Address______</p><p>City ______State______Zip______</p><p>Parent/Guardian(s) Name ______</p><p>Street Address (if different from player above) ______</p><p>City ______State______Zip______</p><p>Daytime Phone______Evening Phone______</p><p>Email______</p><p>Amended June 2013 EASTON YOUTH HOCKEY ASSOCIATION List Ages of Household Dependents ______</p><p>Total amount you can pay toward the total registration fee per player: </p><p>Player 1: ______</p><p>Player 2: ______</p><p>Player 3: ______</p><p>Player 4: ______</p><p>INCOME (Please list the total income received by parent(s)/guardian(s)) Parent/Guardian Name Income (salary, child Amount Received Monthly support, etc.)</p><p>Please give a brief statement for reasons for applying for assistance. List or explain any additional financial circumstances that could impact the Board of Director’s decision (i.e. dependent children in secondary education, dependents with disabilities, recent job layoffs, etc). </p><p>______</p><p>______</p><p>______</p><p>______</p><p>I, the undersigned, understand all information given will be kept confidential, and the information on the above application is accurate and true to the best of my knowledge. If chosen to receive financial aid, I will abide by EYHA adopted Fiscal Policies.</p><p>Amended June 2013 EASTON YOUTH HOCKEY ASSOCIATION ______Parent/Guardian Signature Date </p><p>______EYHA Approval Treasurer Initials Date</p><p>For EYHA Use Only Player Name & Division ______Total Player League Fees______Recommendation: EYHA awards $______</p><p>Amended June 2013</p>