Special Needs Scholarship

Please note: this form is for Special Needs Scholarship requests only.

For General Scholarship information, please fill out our General Scholarship Request.

---

The Safe Haven West Side Basketball League strives to ensure that economic hardship is not an obstacle to participation.

Partial scholarship: Reduced fee: $60 (Use the code Partial23-24 at registration)

If you are human, leave this field blank.

Special Needs Champions Division Scholarship Request

Safe Haven Hoops offers scholarships and reduced fees for qualifying Players and families. If you would like more information or to see if you qualify, please use this form and we will contact you shortly about your options.

Player Name *

Parent or Guardian Name *

Parent or Guardian Email

Parent or Guardian Phone

How would like us to contact you? *

Phone

Email

Please Describe your situation *

Please use this field to describe in a few sentences why you are in need of Scholarship assistance.

Security *

reCAPTCHA is required.

Submit

---

For a mail-in version of our Scholarship Request Form, download the PDF file here.

• General Scholarship Mail-in Form

Mail or Drop off form and payment payable to:

Safe Haven West Side Basketball League
c/o Copy Experts, Box 257, at 2424 Broadway (89th Street), New York, NY 10024.