Application for Assistance - NEW- Protex Sports Foundation

*Must be completed in full, denotes a required field

Application for Assistance

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Full Name *

First Name

Last Name *

Last Name

Address *

Street Address

Street Address Line 2

City *

City

State/Province *

State/Province

Postal / Zip Code *

Postal / Zip Code

Country *

Country

Home Phone Number

Area Code - Phone Number

Cell Phone Number

Area Code - Phone Number

Work Phone Number

Area Code - Phone Number

Email Address *

Sport *

Years playing sport *

Immediate Family Member *

Athlete Sponsor *

Amount of Assistance Requested (select one) *

$250

$500

$1000

Hardship and Need must be a result of hardship, financial or otherwise, injury, or personal life events that may limit the opportunity to participate in training, receive needed coaching, attendance to a sports camp, or participation in an organized sporting activity. An applicant must first demonstrate a hardship which requires charitable assistance. Some examples may include: money for food while training, housing, coaching, travel, or transportation for example.

Describe in DETAIL the circumstances of the hardship or need: *

State the reason(s) for the request: *

List the other resources of assistance you have already pursued and the results. *

PLEASE READ BEFORE SIGNING

I certify this application form has been completed by me and is true and correct. I authorize any member(s) of the Grant Committee to investigate, as necessary, any statements made in this application in order to make a determination regarding my GRANT Request. I understand I will be notified in writing the disposition of my application. Further, I hold harmless the PSF, Board of Advisors, and all other committee members from any and all liability resulting from the disclosure, investigation, and subsequent disposition of the request for assistance.

Date of Application *

Athlete Signature *

Athlete Signature (on behalf of Athlete) *

Parent/Guardian (on behalf of Athlete)

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The Protex Sports Foundation is an independent 501(c) (3) organization approved by the
US Internal Revenue Service. All Donations are Tax Deductible.

Protex Sports Foundation
1564 De Anza Way
San Jose, CA 95125