The U.S. Figure Skating World Team College Scholarship Program Application

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1 The U.S. Figure Skating World Team College Scholarship Program 2017 Application

2 U.S. Figure Skating World Team College Scholarship Program The U.S. Figure Skating Olympic & World Team College Scholarship Program is intended to provide academic assistance to: 1) Olympic & World Team members between 2010 and the present, and 2) full or part-time undergraduate students currently enrolled at an accredited institution. Applicants and awardees may apply consecutively. This application is not open to synchronized skaters. Awards are based on competitive results, financial need, past and present non-financial contributions to U.S. Figure Skating and community organizations, and the applicant s most current GPA status. Funds can be used for tuition, fees, books and room and board, including costs associated with online courses Application deadline: May 15, 2017 The completed application and all supporting documents must be postmarked or received by U.S. Figure Skating by Monday, May 15, Materials may be submitted: By mail, to World Team College Scholarship Program c/o U.S. Figure Skating 20 First St. Colorado Springs, CO By , to By fax, to (719) Failure to meet the criteria and/or the appropriate deadline will result in disqualification. All applicants will be notified of the results via . All selections are considered final and may not be appealed. All Submitted materials will become property of U.S. Figure Skating and will not be returned. PERSONAL INFORMATION Name: Street Address: City: State: Zip: Phone Number: U.S. Figure Skating member number: Discipline: Singles Pairs Dance Have you retired as an Olympic athlete? Yes No Have you received World Team College Scholarship funding before? Yes No

3 ACADEMIC INFORMATION Name of post-secondary institution (currently attending/will attend) in : Will applicant be a full-time or part-time student (please circle)? Street Address: City: State: Zip: Degree/Major: Date of Graduation: / / Cumulative GPA (4.0 scale): What year of college will you be in during the grant period for which you are applying? 1 st 2 nd 3 rd 4 th 5 th Total Tuition Cost (per semester and/or quarter): Will applicant lodge at the institution? Yes No If yes, estimated Room and Board Cost (per semester and/or quarter): Books and Supplies Cost (per semester and/or quarter): Estimated skating training cost for the season, if still active: Will you be receiving any additional academic grants or scholarships during the scholarship period for which you are applying? Yes No If yes, please explain and list the details of the grant(s) or scholarship(s) that you are receiving (i.e. full ride, partial scholarship, U.S. Figure Skating scholarship) and the amount per semester: *Please include an official transcript, including grades through the last reporting period. Transcript must be mailed; faxes or copies will not be accepted. Transcript can be mailed separately or with the rest of the application.

4 FINANCIAL INFORMATION Adjusted gross income for the most recent tax season (tax form 1040, line 37 or tax form 1040EZ or 1040A, line 4): What is your tax filing status? Single Married How many dependents do you have (not including self or spouse), if any? If estimated income for the current year will be less than the prior year, please explain: Do you receive financial support (i.e. parent/spouse/benefactor)? Yes No If yes, please provide the sources and amount of support you receive annually: COMPETITION HISTORY Please indicate the competitions in which you participated and the place in which you finished. If you competed consecutively, please indicate competitions and placements to be the best of your ability. Competition Olympic Winter Games World Championships

5 COMMUNITY INVOLVEMENT Please list all skating-specific activities (i.e. club or U.S. Figure Skating activities, Special Olympics, Basic Skills, committee involvement etc.): Please list all community service activities and awards for the past seven years: Please list all extracurricular activities or unusual circumstances, if applicable:

6 *Additional pages containing community service information or additional information regarding unusual circumstances may be included as an attachment. TERMS AND CONDITIONS As an applicant to the U.S. Figure Skating World Team College Scholarship, under penalty of forfeiture of any funds that may be awarded under this program or any other U.S. Figure Skating funding program, I affirm the authenticity and originality of the information represented in this application. I agree to provide U.S. Figure Skating with updated information should there be a change in information provided herein. By typing my name below, I agree to the rules, guidelines, and procedures stated in this document, and fully understand and accept my responsibilities as a recipient of the U.S. Figure Skating World Team College Scholarship for which I may qualify. I further understand and agree that an electronic signature is a legal and binding signature. Applicant s signature Date Parent or Guardian s signature (If athlete is a minor) Date

7 COMPLETED APPLICATIONS MUST BE SUBMITTED ON OR BEFORE THE APPLICATION DEADLINE. POSTMARKED APPLICATIONS AFTER FRIDAY, May 15, 2017 WILL NOT BE ACCEPTED. Please send application, transcript and any additional supplemental documents to: World Team College Scholarship Program c/o U.S. Figure Skating 20 First Street Colorado Springs, CO Applications will be reviewed by the selection committee. Decisions will be announced within 30 days of the application deadline. All applicants will be notified of the decision at that time.

8 Thank you for your interest in the U.S. Figure Skating World Team College Scholarship Program! Please make a copy of your application and submit the original to U.S. Figure Skating.

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