Request — Maine Youth Sports Opportunity Fund

Request for Grant from MYSOF

Grants are available to qualifying families with kids in grade K-12 on a need and first-come, first served basis as funds are available. Grants can be used for registration, equipment and other associated fees for classes, recreational leagues, and travel sports. The first step to apply for a grant from MYSOF is to fill out this form. A member of our team will contact you within three business days.

First Name

Last Name

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Do you qualify for any of these assistance programs:

Snap, WIC, TANF, Reduced Lunch, MaineCare, SSI

Athlete Name

Athlete Age

Athlete Grade

Sports Program Name

Name of Contact Person

Phone

Cost of Program/Resource/Equipment

Start Date or Funds Due Date

Please tell us about your athlete, the sports program or resource you're requesting funds for, and why you are requesting a grant.

Certification of Accuracy: The following applicants typed or signed full name serves as their digital signature and acknowledgement of this certification of accuracy statement. The named applicant below has reviewed the information provided in this request for grant from Maine Youth Sports Opportunity Fund and certifies that the information provided is true and accurate.

Date

YYYY

If you are not the parent/guardian please provide the below information

Address

Phone

(###)

###

####

Relationship to Parent/Guardian

Social Media Release/Consent

The undersigned parent consents to release of any images and/or video taken of his/her child(ren) taken by any Maine Youth Sports Opportunity Fund (MYSOF) representative, or any media representation for news and/or publicity purposes on MYSOF website, newsletters, publications, bulletin boards, emails and social media sites. I understand that I will not receive numeration for voluntary participation or future use of any images and/or video of my child(ren). I understand that images and/or video for the media and/or world wide web may be used in publications and/or web sites outside of MYSOF control. I understand that I may revoke this consent at any time by notifying MYSOF in writing. This consent expires upon written notice from a parent.

Childs Name

Parent/Guardian Signature