DRUID LAKES YOUTH LACROSSE ASSOCIATION
NEED BASED SCHOLARSHIP APPLICATION
Athlete Name:_____________________________________________________________________
Parent/Guardian Name: _______________________________________________________________
Address: ____________________________________________________________________________
City: __________________________________________________ Zip Code:___________________
Telephone: ___________________(home) _______________(cell)
Email Address:_______________________________________________________________________
Date of Birth: _______________ Grade: _________ School:___________________________________
Parent/Guardian Signature: ______________________________________________Date:___________
Assistance requested:
Registration fee
Equipment Rental
Fill out this form and email to DLYLA at mailing address below with the following attachments:
Documentation showing receipt of assistance such as food Stamps, Medicaid, SSI, Foster Care,
WIC, etc. or documentation demonstrating an immediate financial hardship
Written recommendation by school representatives, social workers, youth community center
workers, or other social services representatives
Send to: DLYLA, 2856 Country Squire Lane, Decatur, GA 30033
--------------------------------------------------------------------------------------------------------------------------------------------
For DLYLA Use Only
Approved ____ Disapproved ____ Amount, if any, Awarded $ ___________
Remarks:______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________