#DiversifyIceHockey Sponsorship ICE HOCKEY About the Scholarship:-open to underrepresented hockey players on a hockey team (synchro and hockey)-funding to support or offset equipment (skates, helmet, pads, private lessons)-must demonstrate noticeable talent at an early age. Application First Name Last Name Email Date of Birth Gender Female Male Transgender Female Transgender Male Prefer Not o Answer Race / Ethnicity American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White Hispanic or Latino Non Hispanic Non Latino Competitive Level Pre - Preliminary Pre - Juvenile Intermidiate Novice Junior Senior Non-USFSA US Figure Skating Number Skating Club Skater Home Rink Video URL web/ address (Youtube etc.) of you skating (competition) Video URL/ web address (Youtube etc.) of you skating (Practice/ Training) Accomplishments (Event, Level, Placement) Do you have at least one underrepresented skater at the international competitive level (eg. Team USA)Do you have at least one underrepresented skater at the National competitive level or on the National developmental team? Upcoming Events? What are your primary needs Support with Ice time costs Support with lesson costs support with skate equipment support with costumes support with travel to competition/ test/ shows Mentorship show opportunities Networks List your top 3 primary needs from the previous question Would you be interested in using preowned equipment? Yes No Maybe What size skate do you wear? What size dress do you wear? What size pants do you wear? XS S M L XL XXL Parent's First Name Parent's Last Name Parent’s/Guardian’s Gross Income for FY 201 Do you receive any other financial support from someone else other than your parent/guardian? * Yes No List sources and amount of support you receive annually (ex. Clothing Co., $1800) Coach's First Name Coach's Last Name Coach's Email Address Home Rink Sumbit