SMB CORNERBACK CASH FUND APPLICATION FORM

Our Win-Win Program, SMB Cornerback Cash Fund provides financial assistance to help with college-related expenses such as tuition assistance, books, school supplies, lab fees, and other school-related costs for underserved student athletes. To qualify a candidate must be a high school senior student athlete who embodies the values of Successful Jocks and is a leader of exceptional character entering their freshman year of college. Candidates must complete this application, upload proof of college acceptance, upload a letter of recommendation from their athletic coach and upload a short video essay between 60-90 seconds long explaining how receiving money from the SMB Cornerback Cash Fund would help you achieve your goals. To be considered, financial documents may be required. Please note that all applicants must be US Citizens, and cannot be signed to or associated with any NCAA santioned college sports teams or organizations.

APPLICANT'S BIOLOGICAL INFORMATION:

FIRST NAME:

LAST NAME:

DATE OF BIRTH:

ETHNICITY:

GENDER:

APPLICANT'S CONTACT INFORMATION:

Address:

CELL PHONE:

EMAIL ADDRESS:

This address will receive a confirmation email

***Please note that SJ will communicate with you via email about the status of your application

TWITTER NAME:

INSTAGRAM NAME:

SNAPCHAT NAME:

***Please note all applicants must follow @successfuljocks on Twitter and/or Instagram to be considered

ARE YOU FOLLOWING @SUCCESSFULJOCKS ON:

TWITTER INSTAGRAM BOTH

APPLICANT'S HIGH SCHOOL AND COLLEGE INFORMATION:

NAME OF CURRENT HIGH SCHOOL:

GRADE:

HIGH SCHOOL ATHLETIC EXPERIENCE:

1 YEAR 2-3 YEARS ALL 4 YEARS

TRAVEL SPORTS EXPERIENCE:

NONE 1-3 YEARS 3 OR MORE YEARS

WHAT SPORT(S) DO YOU PLAY?

COACH NAME:

COACH PHONE NUMBER:

COACH EMAIL ADDRESS:

NAME OF COLLEGE ATTENDING:

PARENT(S)/GUARDIAN(S) INFORMATION:

PARENT/GUARDIAN FIRST NAME:

PARENT/GUARDIAN LAST NAME:

PARENT/GUARDIAN EMAIL ADDRESS:

PARENT/GUARDIAN PHONE NUMBER:

We ask the following questions about the applicant's family financial situation in order to evaluate eligibility for the SMB Cornerback Cash Fund. Successful Jocks is focused on providing opportunities for underserved student athletes, we consider financial need important when selecting applicants for assistance, however SJ will consider other circumstances. *** Please note that all information reported/submitted will be kept strictly confidential and used for the purpose of evaluating this application. If consistered for this award, financial documents may be required.

HOW MANY PEOPLE ARE IN YOUR PARENTS'/GUARDIANS' HOUSEHOLD, INCLUDING YOU?

DO YOUR PARENTS'/GUARDIANS' RECEIVE ANY GOVERNMENT ASSISTANCE?

YES NO

IF NO, WHAT WAS YOUR PARENTS'/GUARDIANS' ADJUSTED GROSS INCOME FOR THE MOST RECENTLY COMPLETED YEAR?

ASIDE FROM FINANCIAL NEED, ARE THERE ANY OTHER REASONS SUCCESSFUL JOCKS SHOULD CONSIDER YOU FOR THIS AWARD? (i.e. raised by single parent, live with foster or adoptive parents, etc) IF SO, EXPLAIN:

APPLICANTS GOALS AND POTENTIAL:

PLEASE ATTACHED A SHORT VIDEO, BETWEEN 60-90 SECONDS (speak clearly) INTRODUCING YOURSELF, STATING YOUR FIRST AND LAST NAME, HIGH SCHOOL, GRADE AND SPORT THEN, EXPLAIN HOW FUNDS RECEIVED FROM THE SMB CORNERBACK CASH FUND CAN HELP YOU ACHIEVE YOUR GOALS:

Upload (8MB)

UPLOAD SUPPORTING DOCUMENTS:

PLEASE ATTACH ONE LETTER OF RECOMMENDATION FROM YOUR COACH, WHO CAN SPEAK ON YOUR CHARACTER AND YOUR CURRENT GOALS AND ACHIEVEMENTS:

Upload (8MB)

PLEASE ATTACH YOUR COLLEGE ACCEPTANCE LETTER:

Upload (8MB)

OTHER RELEVANT INFORMATION:

HOW DID YOU HEAR ABOUT SUCCESSFUL JOCKS & THE WOMEN BEHIND THE UNIFORM?

HONOR CODE AND SUBMISSION:

Please check this box to verify that all information submitted is complete and truthful to the best of your knowledge:

Yes, this information is truthful and to the best of my knowledge.

Typing your name will serve as your signature.

APPLICANT'S SIGNATURE

DATE

SMB CORNERBACK CASH FUND APPLICATION FORM

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