Lancaster County Youth Soccer League Scholarship Application

Name: _____________________________________ SSN:  _________________

Address: __________________________________________________________

City: ______________________________ State: ____    Zip: ________________

Date of Birth: ____/____/____ Telephone (_____) _____________

Email: ____________________

Parent/Guardian Names: _______________________________________________

Club Affiliation: _____________________________________________________

Team: ________________________ Coach's Name: _______________________

Coaches Telephone/Email: _____________________________________________

Name of High School: ________________________________________________

Telephone (_____) _____________ Date of Graduation: _____________________

GPA: ___________  SAT Scores: _____________________

I, certify that I am a high school official and that the above information is true to the best of my knowledge. 

Print Name: ___________________________________  Title: ________________

Signature: ____________________________________________ Date: ________

Name of College or Institution: __________________________________________

Address: __________________________________________________________

City: ________________________________  State: ______ Zip: ______________

Telephone (_____) _____________  Date of Acceptance: ____________________