-- Sean's Fund - Application
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   Serving the Santa Clarita Valley and Children's Hospital Los Angeles
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Application for Financial Assistance

Please Fill Out This Form and Press the Submit Button

After we have reviewed the application, we will contact you to let you know if you have been approved, and if so, at what percentage.

We will also inform Coach Jay so that he can let you know the amount for which you will be responsible. The information you submit is NOT shared with CYCL coaches. It goes to the SRMCF Financial Aid Committee. Your information will not be shared.

School Name
 
Student Last Name
 Student First Name
Parent Last Name
 Parent First Name

Address

City

Zip

Phone

e-mail
Current Yearly Household Income
 Number of Dependents

Is you child enrolled in the free lunch program at school?

Yes No

  

Do You Own or Rent Your Residence?

Own Rent Other

Specify Other

Monthly Mortgage or Rent

  

Assistance Requested

25% 50% 75%

 

Program

Specify Event

Session Start Date

Session End Date

Session Type

Short Long