Scholarship Form - Pelican Park - Recreation District #1

YOUTH ATHLETIC SCHOLARSHIP FORM

Recreation District #1 (Pelican Park) offers a scholarship program for children who need financial assistance in order to participate. Please state your reason for requesting a scholarship and the staff will review all requests to determine eligibility. A scholarship is only offered to those with special circumstances and only to residents of Recreation District #1 during the regular registration period.

A Park staff member may contact you to discuss financial aid. If granted, coaches, volunteers, and age group directors will not be aware your child is receiving a scholarship.
Scholarships are only granted to District residents.
Scholarships do not include any equipment for the program or transportation to and from practices, games, etc.
Proof of financial need (e.g., SNAP, Medicaid, TANF, Free/Reduced Lunch) must be submitted with this form. If your proof of financial need is a food stamp card or a Medicaid card, we will need a copy of your most recent letter showing that it is current.

Scholarships are available to District Residents only and are pending approval from Pelican Park Staff.

Appeals Process
Applicants who are denied a scholarship may submit a written appeal to the Executive Director within ten (10) business days of notification. The decision of the Executive Director on appeals is final.

Company

This field is for validation purposes and should be left unchanged.

Name of Child or Participant(Required)

First Last

Name of Parent/Guardian(Required)

First Last

Phone(Required)

Email(Required)

Address(Required)

Street Address City State ZIP Code

Sports Program Requested(Required)

Are you presently on federal assistance?(Required)

Yes

What documents are you providing to support proof for financial need?(Required)

What volunteer activities would you be willing to do in exchange for a scholarship?

Head Coach

Assistant Coach

Concessions

Other

IN ORDER TO QUALIFY YOU MUST FILL OUT THE FOLLOWING INFORMATION.

This scholarship is available to those with special circumstances and requires proof of financial aid received. Please explain why you need this scholarship.(Required)

Relationship Disclosure Statement

Please disclose any familial, household, personal,or other relationship between the applicant, parent/legal guardian, or household member and any employee, board member, coach, contractor, volunteer, or affialted representative of Recreation District #1.

If a relationship exits, please identify the individual and describe the nature of the relationship:

Proof of financial need (e.g., SNAP, Medicaid, TANF, Free/Reduced Lunch) must be submitted with this form.(Required)

If your proof of financial need is a food stamp card or a Medicaid card, we will need a copy of your most recent letter showing that it is current.

Drop files here or

Max. file size: 128 MB.

By signing this application, the undersigned certifies that they are the parent or legal guardian of the applicant and that all information provided in this application is true, complete, and accurate. The undersigned further acknowledges that failure to disclose a known relationship or the intentional misrepresentation of information may result in denial or revocation of scholarship assistance, may subject employees to discplinary action in accordance with district policies, and may be referred to law enforcement or other appropriate authorities for investigation and possible prosecution.

Name of Parent/Legal Guardian Submitting Application:

Signature of Parent/Legal Guardian Submitting Application:

Date:

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