SCHOLARSHIP APPLICATION

MUSTANG YOUTH SOCCER ASSOCIATION (MYSA)

(This is a one-year $500 scholarship application)

Please complete the following information and return to Mickey Claxton (MYSA President) by May 1, 2010 or return to address provided below. This will be an agenda item for vote on May 13^th, 2010 by the MYSA executive board.

Name: __________________________________ Date of Birth: _______________

Street Address: ___________________________

City/State/Zip: ___________________________

Soccer Experience

Total years participation in High School Soccer (2 year minimum): ______

Total years participation in MYSA (2 year minimum): ______

Scholastic and Community Involvement

Extra curricular activities and office held:

Honors and Outstanding Achievements:

Scholastic Achievement (attach transcript from school)

Grade point average: ________ SAT or ACT Score: ______

Continuing Education Plans

College/University attending during 2010-2011 Academic year: _______________

__________________________________________________________________.

Scholarship Information

1. Explain on an additional sheet of paper why you would like to be awarded this scholarship and why you need this scholarship for your continuing education.

2. Please include two character reference letters.

3. Return to Mickey Claxton, MYSA President, by contacting 445-7530 or mailing by May 1, 2010 to 800 Cabillo Way, Mustang, 73064.

I, the undersigned, pledge that to the best of my knowledge, all of the above information is true and accurate as of _______________.

(date)

Student Signature: __________________________

Parent Signature: __________________________

__________________________

(Printed Name)