Mark West Foundation - Mark West Foundation

Application Form

The name of the child must match the name of the child on the Health Care/Pension Card

If using a phone to apply, please have your HCC or pension card on hand

If using a computer/laptop to apply, please have a picture saved of your HCC/Pension Card saved on your computer/Laptop before starting

If applying for more than 1 child, a separate application must be filled out for each child

* Required

ITEMS/ EQUIPMENT THAT YOU WISH TO APPLY FOR:

Please indicate the items that you require to participate in your club, (NOTE: Please choose only those that are the most important for you to begin participation as not everything may be able to be funded).

SUPPLEMENTARY INFORMATION (NOT COMPULSORY)

As this application form is the only way of assessing families, could we please ask that you briefly detail the issues & problems you face. We understand this might make people feel uncomfortable so this section is not compulsory.

Copy of Health Care Card/Pension Card *

Declaration:

The Declaration must be signed by the parent guardian or a designated support person/referee aged over 18 years:
I have read and understood the accompanying conditions and guidelines of The Mark West Foundation Scholarship Program. I state that the information in this application is to the best of my knowledge true and correct. I acknowledge that the program coordinator will need to discuss this application with the Selection Panel and a designated person from the Football Club listed for verification, assessment, advice or comment. I agree to abide by the conditions outlined by The Mark West Foundation Scholarship Program, and accept the decision made by the selection panel. I understand that this is an application only and may not necessarily result in funding approval.
Accept terms and conditions *

Club Membership fee
Football Boots(US Size)	2 3 4 5 6 7 8 9 10 11 12 13 14
Football Shorts	3XS - 26 XXS - 28 XS - 30 S - 32 M - 34 L - 36 XL - 38 XXL - 40
Football Socks(US Size)	Junior 9 - 2 Youth 2 - 7 Adult 7 - 11 X - Large 11 - 14
Uniform	Hoodie Polo Other

Application Form

ITEMS/ EQUIPMENT THAT YOU WISH TO APPLY FOR:

SUPPLEMENTARY INFORMATION (NOT COMPULSORY)

Declaration:

Major Supporters:

The Latest News:

2020 Scholarship Program

2019 Golf Day