Town of Mamaroneck / SPORTIME Harbor Island Scholarship Form

APPLICANT INFORMATION

First Name *

Last Name *

Date Of Birth *

Gender

Gender *

Male

Female

School *

Grade *

PARENT / GUARDIAN INFORMATION

Parent/Guardian First Name *

Parent/Guardian Last Name *

Parent/Guardian Email *

Parent/Guardian Confirm Email *

Parent/Guardian Mobile Phone * Required Format: US - (555) 555-5555

Parent/Guardian Home Phone Required Format: US - (555) 555-5555

Parent/Guardian Employer Name

Parent/Guardian Position with Employer

Employer Contact information for Employment Verification

Second Parent/Guardian, if applicable

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Email

Parent/Guardian Confirm Email

Parent/Guardian Mobile Phone Required Format: US - (555) 555-5555

Parent/Guardian Home Phone Required Format: US - (555) 555-5555

Parent/Guardian Employer Name

Parent/Guardian Position with Employer

Employer Contact information for Employment Verification

APPLICANT HOME ADDRESS

Street Address *

Street Address Line 2

City *

State*

Postal / Zip Code *

Country *

SECOND APPLICANT HOME ADDRESS, IF APPLICABLE

Street Address

Street Address Line 2

City

State

Postal / Zip Code

Country

ADDITIONAL INFORMATION

Applicant T-Shirt Size *

BACKGROUND INFORMATION

Have the applicant ever played tennis and/or participated in tennis programs?*

Yes

Is the applicant currently participating in tennis programs? *

Yes

Does the applicant have a USTA membership, a WTN number or UTR?*

Yes

If a scholarship is awarded, will the applicant be able to play in local tournaments and events recommended by SPORTIME?*

Yes

In what other sports does the applicant participate ? (Check all that apply)

Basketball

Baseball

Pickleball

Football

Martial Arts

Soccer

Swimming

Other

Is the applicant involved in extracurricular and/or volunteer activities? *

Yes

What do you want to be when you grow up?

Why is tennis the applicant’s sport of choice? And, what tennis-related aspirations does the applicant have?

FINANCIAL INFORMATION

Household Income *

All application information provided will be deleted when no longer needed for evaluation of scholarship consideration.

DISCLAIMER- PLEASE READ:

By signing below, I agree and represent that I am the parent or legal guardian of the applicant, and I hereby authorize SPORTIME Clubs, LLC d/b/a SPORTIME to verify parent/guardian employment and income, and related information. SPORTIME may request additional information, for income eligibility verification purposes, such as tax returns. The information submitted, and any information procured pursuant to verification, will be kept confidential, and will be utilized by SPORTIME solely for the purposes of determining applicant’s eligibility for a scholarship to participate in SPORTIME Harbor Island programs. Scholarships are granted to applicants in SPORTIME’s sole and absolute discretion, using any criteria that SPORTIME may deem appropriate, from time to time, and may be withdrawn by SPORTIME at any time and for any reason, including after issuance. If I am granted a full or partial scholarship, I agree not to share the terms and details of such scholarship with others.

AGREE TO TERMS

I understand and agree to these application terms *

Spam Prevention *

By clicking submit, you acknowledge that all information is true and correct.

SPORTIME HARBOR ISLAND SCHOLARSHIP APPLICATION