Baseball assistance team 245 Park Avenue, 31st Floor New York, ny 10167
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- IMPORTANT: ANSWER ALL QUESTIONS
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- BASEBALL EXPERIENCE / RELATIONSHIP
- SOURCES OF INCOME (HOUSEHOLD)
BASEBALL ASSISTANCE TEAM245 Park Avenue, 31st Floor New York, NY 10167212-931-7822 Fax: 212-949-5433 T GRANT APPLICATIONoll Free: 866-605-4594The following is an application for a Baseball Assistance Team (B.A.T.) Grant. Please fill out this application as completely as possible. Any blank areas may hold up the decision process, as government regulations require us to have detailed information. Once you have completed the form, return it to the address above. If you have any questions, please call. IMPORTANT: ANSWER ALL QUESTIONS(Please print in ink) GENERAL INFORMATION TO BE COMPLETED BY APPLICANTName: _______________________________________________________ E-Mail: _______________________________________Address: ____________________________________________________________________________________________________ City: _____________________________________ State: _________________________ Zip Code: _________________________ Date of Birth: _________________________________________ Home Telephone: ( ) ________________________________ Social Security #: ______________________________________ Work Telephone: ( ) ________________________________ In case of emergency, contact: Name: _____________________________________ Telephone: ____________________________
RELEASE OF INFORMATIONIN ORDER TO HELP YOU, B.A.T MUST BE ABLE TO VERIFY ALL INFORMATION I authorize B.A.T. or its duly authorized representatives to contact, in person and/or by phone, all persons, creditors, banks, businesses, doctors, hospitals, and consultants and/or therapists, etc. listed herein for the purpose of verifying or obtaining additional information. I further release B.A.T. and its duly authorized representative from any and all responsibility resulting from the release of any such information. Signed: __________________________________________________________________ Date: ____________________________ Print Name: _________________________________________________________________________________________________MARITAL STATUSSingle Married Widow/Widower Divorced Spouse Information: Name: _____________________________________________________________________________________________________ Date of Birth: _________________________________________ Social Security #: ______________________________________
GRANT APPLICATIONLIVING ARRANGEMENTSDo you live alone? Yes No With another family ? Yes No With spouse? Yes No With other relatives? Yes No With children? Yes No In a retirement home? Yes No Others? Yes No If yes, name of person ________________________
BASEBALL EXPERIENCE / RELATIONSHIPPlease list teams and years of experience that you or your spouse had in the Major, Minor or Negro Leagues. TEAM(S) YEAR(S) ___________________________________________________________________ ____________________________ ___________________________________________________________________ ____________________________ ___________________________________________________________________ ____________________________ ___________________________________________________________________ ____________________________ ___________________________________________________________________ ____________________________ ___________________________________________________________________ ____________________________ If you or your spouse did not play baseball, what is your or your spouses connection to baseball? (Umpire, Front Office, etc.) ORGANIZATION(S) YEAR(S) ___________________________________________________________________ ____________________________ ___________________________________________________________________ ____________________________ ___________________________________________________________________ ____________________________ ___________________________________________________________________ ____________________________ GRANT APPLICATION INCOME SOURCES OF INCOME (HOUSEHOLD)Per Month Per Year A. Social Security Yes No _____________________________ ___________________________ Disability Yes No _____________________________ ___________________________ Baseball Pension Yes No _____________________________ ___________________________ Other Pension Yes No _____________________________ ___________________________ Veteran’s Benefits Yes No _____________________________ ___________________________ Other Sources ** Yes No _____________________________ ___________________________ Employment Yes No _____________________________ ___________________________ TOTAL (also record on page 6) _____________________________ ___________________________ ** Interest Income from Mutual Funds (i.e. Vanguard Funds, Fidelity Funds, etc.) Stocks, Life Insurance Policies, Annuities, etc. or Major League Baseball Players Association Licensing Money B. Employment Are you employed? Yes No Employer’s Full Address and Phone Number: _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ ( ) __________________________ If you are unemployed: Are you able to work? Yes No If you are unable to work, please list reasons: ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________
Bank Address: ________________________________________________________________________________ Phone Number: ( ) _________________________________________________________________________ Bank Account Number: ________________________________________________________________________________ Current Balance: ________________________________________________________________________________
Bank Address: ________________________________________________________________________________ Phone Number: ( ) _________________________________________________________________________ Bank Account Number: ________________________________________________________________________________ Current Balance: ________________________________________________________________________________
OTHER ASSISTANCEAre you receiving any public or private assistance? If yes, please explain the nature of the assistance: _____________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________
____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ GRANT APPLICATION EXPENSES DWELLING EXPENSESMortgage: Is help needed with the mortgage? Yes No If the answer is yes: What is the total amount of your mortgage? ____________________________ What is the value of your home? ____________________________ What is your monthly mortgage payment? ____________________________ Date of expected mortgage completion? ____________________________ Are you current with your payments? Yes No Number of years at current address? ____________________________ If the answer is no: How many months are you behind with payments? ____________________________ Total amount needed to bring you current ____________________________ Please list the name and address of mortgage holder: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Telephone Number: ( ) ______________________________________________________________________________ Rent: Is help needed with the rent? Yes No If the answer is yes: What is the total amount of your monthly rent? ____________________________ Are you current with your payments? ____________________________ Number of years at current address? ____________________________ If the answer is no: How far are you behind with your payments? ____________________________ Total amount needed to bring you current? ____________________________ Please list the name and address of landlord: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Telephone Number: ( ) ______________________________________________________________________________
HOUSEHOLD EXPENSESMONTHLY EXPENSES Food $____________________ Health Insurance $____________________ Clothing $____________________ Life Insurance $____________________ Transportation $____________________ Homeowners Insurance $____________________ Household Supplies $____________________ Auto Insurance $____________________ Maintenance Fees $____________________ Auto (Loan or Lease) $____________________ Mortgage/Rent $____________________ Child Care / Alimony $____________________ Cable / Dish $____________________ Prescriptions $____________________
Electricity ______________________ ________________________ ____________________________ Gas ______________________ ________________________ ____________________________ Water ______________________ ________________________ ____________________________ House Telephone ______________________ ________________________ ____________________________ Cell Phone ______________________ ________________________ ____________________________ TOTAL MONTHLY EXPENSES $________________________________ TOTAL MONTHLY INCOME $__________________________________ (From Total on Page 3) UTILITIES Is help needed with the utilities? Yes No If the answer is yes: Are you current with your payments? Yes No If the answer is no, what is the total amount to bring you current? $______________________
____________________ __________________________ _________________ _________________ ____________________ __________________________ _________________ _________________ ____________________ __________________________ _________________ _________________ ____________________ __________________________ _________________ _________________ ____________________ __________________________ _________________ _________________ NOTE: These expenses must be documented with copies or the actual bills when requested. DO NOT SEND BILLS AT THIS TIME. GRANT APPLICATION MEDICALIs help needed for your medical needs? Yes No If the answer is yes, describe your medical needs or disabilities: _________________________________________ ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Are you covered by : Medical Insurance Yes No Dental Insurance Yes No Medicare Yes No Medicaid Yes No Other ______________ Yes No
HOSPITALIs help needed with a hospital? Yes No If the answer is yes, what is the total of your bill? _____________________________________________________ Are you current with your payments? Yes No If the answer is no, how many months are you behind with your payments? ________________________________ What is the amount needed to bring you current?______________________________________________________ (If answer is yes, and help is needed, you must fill out the enclosed medical expense form). DOCTORSIs help needed with doctors? Yes No If answer is yes, what is the total of your bill? ________________________________________________________ Are you current with your payments? Yes No If answer is no, how many months are you behind with your payments? ___________________________________ What is the amount needed to bring you current? _____________________________________________________ (If answer is yes, and help is needed, you must fill out the enclosed medical expense form).
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Should you feel a need to add more information, please feel free to use this space. We would appreciate any additional information you would like to provide us. ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ BASEBALL ASSISTANCE TEAM 245 Park Avenue34th Floor New York, NY 10167 (212) 931-7821/7822
Name: ______________________________________________________________________________________________ Address: _____________________________________________________________________________________________ City: ________________________________________________ State: ___________________ Zip: __________________ Home Telephone: ( ) ________________________________ Work Telephone: ( ) __________________________ If I am not available, please contact: Name: _______________________________________________ Telephone: ( ) _______________________________
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