Stein Eriksen Dare To Dream Application Apply for YSA Stein Eriksen “Dare to Dream” Scholarship Online Annual YSA Stein Eriksen "Dare to Dream" Scholarship Application Date* MM slash DD slash YYYY Important InformationThe purpose of the YSA Stein Eriksen Dare to Dream Scholarship program is to provide financial assistance to deserving athletes enrolled in Youth Sports Alliance member programs, who cannot participate or compete without the help of scholarship funding. Funds for the scholarships are provided by the Stein Eriksen YSA Opportunity Endowment and scholarship donations raised through JANS Winter Welcome, an annual fundraising dinner.*Please use Safari or Chrome browser to complete application. Before completing your application, please read the following: Scholarship Criteria Document I have read the YSA Stein Eriksen Endowment Dare to Dream Scholarship Criteria and Funding 2022/23 document and confirm I meet all requirements. I acknowledge that all required documents with this application must be recieved by YSA during the application period August 1-August 31. Late or incomplete applications may not be eligble for a scholarship. Funding Information: Please read thoroughly, see Scholarship Criteria & Funding Document for more detailed information*The Annual Scholarship is designed to help the athlete identify their yearly expenses and request the funding amount they need assistance with to keep them in their sport. Fall requests should cover their annual year (Fall through Summer). Appproved expenses include annual program fees, team supported competition entry & travel fees, camps that are within the team's annual training program which the athlete pays directly to their team. Unapproved expenses include camps that are not run through their team, commercial camps, equipment, team camps that are not skill based for their sport, post season camps or competitions in which athlete must qualify for (use spring scholarship) I understand the annual scholarship funding will cover the entire year (fall-summer). Applicant InformationYSA does not discriminate on the basis of religion, race, color, sex, ancestry, sexual orientation, disability, national origin, or any other protected category in accordance with applicable federal, state and local laws.Applicant First Name* First Applicant Last Name* Last Date of Birth* Age*Please read age requirements in Scholarship Criteria Athlete's Email* Athlete's Phone Number* Mailing Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Parent or Guardian's Name* First Last Parent or Guardian's Email*If applicant is under 18 years of age, parent/guardian's email provided will be used for all communication Parent or Guardian's Contact Phone Number* Relationship to Athlete* Mother Father Legal Guardian Team Name*Please select oneFigure Skating Club of Park CityPark City Ice MinersPark City Ski and Snowboard - Alpine DivisionPark City Ski and Snowboard - Freeski DivisionPark City Ski and Snowboard - Freestyle MogulsPark City Ski and Snowboard - Freestyle AerialsPark City Ski and Snowboard - Nordic DivisionPark City Ski and Snowboard - Ski Mountaineering DivisionPark City Ski and Snowboard - Snowboard DivisionPark City Speed Skating ClubWasatch Luge ClubWasatch FreestyleUOP Bobsled and Skeleton ClubDiscipline* Current Level* Years with Team* Coach's Name* Applicant's SchoolEcker Middle SchoolTreasure Jr. HighPark City High SchoolJeremy Ranch ElementaryMcPolin ElementaryParley's Park ElementaryTrailside ElementaryWinter Sports SchoolPC Day SchoolOtherSchool - OtherIf you selected "other" in the question above, please list the school you attend. If you were able to select school from list above, skip this question. Applicant's GPAPlease indicate overall GPA range below, if applicable.4.0 or higher3.75-3.993.5-3.743.0-3.492.5-2.992.5 or belowIf you are a member of a National Team please list name and level: If you are a member of a National team, please indicate the funding provided by the National Team YSA encourages multisport participation. If you participate in other sports, please list here: Cost and Funding InformationCost of Program FeesAnticipated cost of program fees for the year (fall - summer). Do not include competition, travel, or camp fees. Funding request for Program Fees*Amount of funding applicant is requesting toward program fees for the year. Please be aware that YSA is unable to fully fund an athlete's program.Competitions applicant plans to attend during the regular seasonPlease list planned seasonal competitions, locations, and dates for annual year. Example: IFSA Regional, Big Sky Montana Jan 22 & 23. Nordic Regional, Jackson Wy, Feb 4-8Cost of Competitions & TravelPlease include competition fees and travel expenses for all anticipated competitions. Funding request for Competitions & TravelAmount applicant is requesting to aid in cost of anticipated competitions and travel.Camps applicant plans to attend during the regular annual seasonThese are for camps put on through the team. Do not include any invitational-post season camps which the Spring Scholarship will cover. List name of camp, location, and dates.Cost of campsCost of camps approved by YSA Scholarship Criteria.Funding request for campsAmount of funding you are requesting to aid in the cost of camps.TOTAL COSTS*Please include costs for program fees, competitions, travel, and camps that your family will incur. This should be the total from the above "cost" questions.TOTAL FUNDING REQUESTED*This is your total scholarship funding request. Please include request amounts for program fees, competitions, travel, and camps. This should be the total from the above "funding requested amount" questions.How much funding has applicant received from YSA Stein Eriksen Opportunity Endowment?*Please indicate the total funding athlete has ever received from YSA in the past.$0-$500$500 - $1000$1000 - $2000$2000 - $3000$4000 - $5000$5000 - $7500over $7500Are you expecting funding from other sources this year?* Yes No If you answered "yes" from above question, list the sources of funding and amounts. Does the applicant participate in the Free and Reduced Lunch Program?* Yes No Required DocumentationEach applicant is required to provide specific documentation regarding financial need, including but not limited to the past two years' tax returns. If applicant is part of a multi-household family, tax returns must be provided for all households (all financial supporters), even if applicant is over 18 years of age and submits an individual tax return. Tax Documents: Past 2 years tax forms 1040 (first 2 pages only). Include additional documentation if applicable such as tax documents for all parents, guardians, or others who are finacially resposible for applicant, business forms for business owners, etc.*Upload here: Drop files here or Select files Accepted file types: jpg, pdf, Max. file size: 128 MB. Upload Additional Information hereIf applicable, upload any additional information that will help the Scholarship Committee better understand your financial need. Drop files here or Select files Accepted file types: jp, pdf, doc, docx, xls, csv, xlsx, txt, Max. file size: 128 MB. Upload Applicant Letter*Applicant must provide a letter with the following information: a) Why should you be considered for the YSA Stein Eriksen Dare to Dream Scholarship? b) What are your goals in your sport program? c) How does this program affect your life? d) Read the YSA Core Values and explain what these values mean to you and your future. e) Include any personal financial contributions to your sport such as employment, personal fundraising, etc. f) Add any additional information that might be helpful in evaluating your application. Drop files here or Select files Accepted file types: jp, pdf, doc, docx, xls, csv, xlsx, txt, Max. file size: 128 MB. Coach's Recommendation Form*Notify your program director or coach of your application well in advance of deadline; and ask him/her to complete the Coach's Recommendation Form on your behalf. The form can be found and completed on our website at ysausa.org under About/Competitive Teams. This form will remain confidential. I understand it is my responsibility to have the Coach's Recommendation Form completed and received by YSA prior to the application deadline. I understand the Coach's Recommendation Form is confidential between the coach and YSA. End of Season Scholarship Recipient Report*At the end of your season, fill out the End of Season YSA Stein Eriksen Dare to Dream Scholarship Recipient Report, and email to YSA. YSA End of Season Report I acknowledge that if I receive a YSA scholarship it is my responsibility to complete the End of Season Report. Future funding is dependant on completion of this requirement. Thank You Letters*Our donors love to hear from you! Please write two Thank You Cards, addressed to "Dear YSA Donor" and mail to YSA at PO Box 681698 Park City, Utah 84068 I acknowledge that if I receive a YSA scholarship it is my responsibility to complete two Thank You cards. Future funding is be dependant on completion of this requirement. YSA Privacy Policy*YSA Privacy Policy I have read and accept the YSA Privacy Policy I authorize YSA to use my name for marketing, granting, and public relation purposes.* Yes No I would like to represent YSA at public events such as fundraisers, radio and/or T.V.* Yes No Consent*To the best of my knowledge, I hearby certify that all documentation I provided is accurate, complete, and true Athlete ApprovalConsent*To the best of my knowledge, I hearby certify that all documentation I provided is accurate, complete, and true Parent/Guardian Approval Δ
