USTA MARYLAND DISTRICT



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2006 Multicultural Participation Grant

Junior Tournament Player Application

please read the following carefully before filling-our form. in an effort to increase multicultural participation in the section, usta mid-atlantic offers financial assistantce to developing junior tournament players who reside in maryland, virginia, washington dc, and west virginia.

Because this opportunity is intended specifically for the “tier two” emerging player (i.e. those with rankings below the top 100 nationally, but in the top 100 in the section), the awarding of these grants is based, in large part, on the review committee’s assesment that a grant will contribute directly to the player’s prospects for becoming “tier one” top-100 nationally-ranked player.

DEADLINE: applications must be submitted by November 17, 2006 and will be reviewed by the multicultural participation committee at its next scheduled meeting.

if you have questons as you complete this form, contact Janice Reardon, at 703-556-6120. return to: usta/Mid-Atlantic, 7926 jones branch drive, suite 120, Mclean, VA 22102; fax 703-556-6175, Attn: Janice Reardon; or e-mail Reardon@mas..

I. Contact Information (Parent/ Guardian must complete this form)

Ms/Mrs/Mr Name relationship to applicant

Address (if different from applicant’s address)

City, State, Zip

( ) ( ) ( )

Work Phone Fax Home Phone e-mail

does your fmaily have access to the internet? ( Yes ( No

II. Applicant Information (Junior Player)

Full Name Player’s USTA membership Number

Address

City, State, Zip

( ) ( Boy ( Girl

Home Phone Gender

What is you race and your ethnicity? Please check all that apply.

( African American ( Asian/ Pacific Islander American ( Caucasian

( Hispanic/ Latino ( Native American ( Biracial

III. Tell us more about yourself (Junior Player)

EDUCATION:

What school do you attend?__________________________________________________________

School Address: ___________________________________________________________________

what grade are you entering? _____________________

TENNIS PARTICIPATION:

Previously Program Current Year

( high school teams _______

( usta sanctioned tournaments _______

( usa wheelchair tennis programs _______

( others __________________ _______

Current Singles Ranking/ Standing: District: _______ Section: _______ National: _______

Current Doubles Ranking/ Standing: District: _______ Section: _______ National: _______

Do you train at a particlar tennis facility? ________________________________________________

Do you have a coach? Who? ____________________________________________________________

( letter of recommendation from coach attached (strongly encouraged)

EXTRACURRICULAR/ COMMUNITY INVOLVEMENT:

Please list any extracurricular or community service activities in which you are involved:

_____________________________________________________________________________________

_____________________________________________________________________________________

Have you received any special awards? If so, please list:

_____________________________________________________________________________________

_____________________________________________________________________________________

IV. Family Financial Information

Father’s name: _________________________________ Home Phone: _________________________

Occupation: ___________________________________ Present Employer: ____________________

Work Phone: _________________________________ Annual Salary: ________________________

Mother’s Name: _________________________________ Home Phone: ________________________

Occupation: ____________________________________ Present Employer: ___________________

Work Phone: ___________________________________ Annual Salary: _______________________

Total household income: _________________________________________________________________

Total Dollar Amount spent on the applicant’s tennis development in previous year: ________________

Does applicant presently receive finanacial assistant for tennis from any source othen than parent (s)

or guardian? ( Yes ( No If yes, who? _______________________

Have you ever received any other USTA National, USTA Section or USTA District finanacial support?

( Yes ( No if yes, state year received _________

Grant amount requested: $ ______________ (Grants genereally range from $250 to $500)

If awarded, how would the funds from this grant be used? ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Signature of Junior Player: ____________________________ Date _______

Signature of Parent/Guardian: _________________________ Date ________

Deadline: November 17, 2006

(Grant amounts are contingent on funding availability)

Player Grants also are available from the Mid-Atlantic Tennis and Education Foundation.

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