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LMHS Youth League Scholarship Application

Youth League Scholarship Information

Licking Memorial Health Systems (LMHS) provides registration fee scholarships to children who, without this financial assistance, might not be able to participate in one of Licking County’s youth recreational athletic leagues. The LMHS Youth League Scholarship program provides opportunities for area youth to participate in recreational team sports as part of our mission to improve the health of the community. Participation in recreational team sports provides physical, mental, and character-building benefits.

Currently, LMHS Youth League Scholarships are being offered for, but not limited to, the following leagues:

  • AYSO Soccer
  • Buckeye Valley Family YMCA Leagues
  • Granville Recreational District
  • Heath Sertoma Youth Athletic Association
  • Johnstown Youth Athletic Association
  • Lakewood Youth Baseball Association
  • Lakewood Youth Softball Association
  • Licking County Sports Association
  • Licking Heights Youth Association
  • Licking Valley Youth Biddy Football League
  • Licking Valley Youth Sports Association
  • Miller Park Diamond Association
  • Mound City Little League & Softball
  • Newark Area Soccer Association
  • Newark Ice Hockey Association
  • North Fork Youth Athletic Association
  • North Newark Little League
  • Northridge Youth Athletic Association
  • Pataskala Parks and Recreation Programs
  • St. Louisville Youth Leagues
  • Southwest Licking Youth Baseball League
  • Southwest Licking Youth Association, LLC
  • Summit Station Licking Heights Youth Football Association
  • Upward Basketball
  • Utica Youth Athletics
  • Watkins Youth Softball

If you have any questions or need assistance completing the LMHS Youth League Scholarship application, please call the Development Department at (220) 564-4102, Monday through Friday, from 8:00 a.m. to 4:30 p.m.


To be eligible for the LMHS Youth League Scholarship program:

  • Athlete must be a Licking County resident.
  • Athlete must be age 15 or younger.
  • Household income must not exceed 250 percent of the federal poverty income guidelines.
  • Athlete participates in a minimum of 80 percent of the scheduled practices and games.
  • Participation by a family member in at least one (1) volunteer opportunity during the scholarship season.
  • Athlete or parent must have completed the youth league’s registration form.
  • Application must be completed by a parent, guardian, or head of household, with all requested information provided.

Please provide the total gross income for the 3 months and 12 months immediately preceding the date for which assistance is required. This must include income for everyone living in the home. Write the total gross income in the space provided on the application on the next page. Self-employed applicants must provide gross income, less reasonable business expenses. Personal expenses are not permitted.

Proof of income is required. Examples of acceptable income verification include:

  • Check stubs for 3 and 12 months
  • Documentation of Social Security, unemployment compensation, alimony, child support or pensions

If the household earned $0 income, please complete the voucher on page 4 of this application.


Option 1: Download, Print and Mail in Application

Click here to download the Youth League Scholarship Application (PDF)

Please return the completed application to:

Licking Memorial Hospital
Development Department
1320 West Main Street
Newark, Ohio 43055

Option 2: Complete Application Form Online

Please complete the following form in its entirety.

For suggestions on local leagues for which the scholarship may be applicable, please visit the Sports Activity Resources page. 

If you have any questions or need assistance completing the LMHS Youth League Scholarship application, please call the Development Department at (220) 564-4102, from 8:00 a.m. to 4:30 p.m., Monday through Friday.

Athlete Lives With:
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Please provide the following information for all of the members of the household - include everyone living in the home. Provide gross family income for the past 3 months and the past 12 months. Include income from employment, Social Security (SS), Supplemental Security Income (SSI), unemployment compensation, alimony, child support and pensions.

Name Birthdate Relationship to athlete Gross income for past 3 months Gross income for past 12 months
Total persons in household:
Total family income:
Terms and agreements:

Licking Memorial Health Systems