Canby Junior Basketball Association
2016 Scholarship Request Form
Canby Junior Basketball (CJBA) is a non-profit, volunteer organization. Our primary goal is to serve the
community and to offer community children a chance to participate in youth basketball. The fees
associated with participating in this activity have been established to cover the cost to operate this
youth organization. It is the desire of CJBA to offer basketball opportunities to as many children within
the community as possible. CJBA strives to provide scholarships, to be applied toward registration fees,
to families facing financial hardships. CJBA, PO BOX 1084, Canby, OR 97013
Name
1.
2.
3.
Parent/Guardian(s) Name:
Phone-Home:
Mailing Address:
Player(s) Information
Program
Grade
Work:
Cell:
Email:
Registration Fee*
Scholarship Information
1. Volunteer time is a large contributor in deferring cost for the organization and is required of all
participants in our scholarship program. Participants will be contacted by a member of the
Board and asked to assist with a special project or one of the following activities:
Set-up/take-down and errands at one of the Canby Tournaments (weekend in Jan)
Assist with concession/admission at one of the Canby Tournaments (weekend in Jan)
Run score clock at Rec/Competitive Tournament (weeknight in mid-March)
2. Did your family receive a CJBA scholarship last year? __________________
3. What amount of the total registration fee(s) are you able to pay? __________________
4. In a paragraph below, explain in as much detail as possible why you are applying for a
scholarship for your child/children:
I certify that the information provided above is true. I understand that submission of this form
does not guarantee a scholarship. I also understand that I am responsible for any balance that
remains after a scholarship has been issued.
X
Signature of parent/legal guardian
The remaining balance, after scholarship is due to CJBA prior to your team’s first practice.
Registration Fees: Traveling League-(4th/5th/6th): $275
(7th): $350 (8th)$400
st nd
In Town League-(1 /2 ): $100
(3rd/4th): $150
SCYBA -(3rd/4th Girls): $175
(5th/6th Boys): $250
th th
Wilsonville Rec -(7 /8 Boys): $225
The remaining balance, after scholarship is due to CJBA prior to your team’s first practice.
CJBA Use Only
Board Acknowledgment: ________ Result: _____________
Payment Plan Established: ______