2. Participant Information
4. For which program are you requesting a scholarship?*
6. Program Code:*
7. Cost of the program:*
9. Are there siblings also registering for the same program?*

   1. Yes
   2. No

   (One application per request per participant)
10. How many siblings?
12. First Name:*
13. Last Name:*
15. Age:*
16. Grade:*
18. Address:*
20. City:*
21. State:*
22. Zip Code:*
24. Parent/Guardian:*
25. Day Phone:*
27. Evening/Cell Phone:*
28. Email:*
32. Household Details
34. Family's estimated total monthly income:*
35. Family's estimated total monthly expenses:*
37. Parent #1
39. Name:
40. Current Year Estimated Wages:
42. Parent #2
44. Name:
45. Current Year Estimated Wages:
47. Guardian
49. Name:
50. Current Year Estimated Wages:
52. **Please include copies of your recent pay stub, last year’s tax return, or other proof of financial need.** *
54. Number of Adults in Household:*
55. Number of Children in Household:*
57. APPLICATIONS CANNOT BE PROCESSED WITHOUT PROOF OF INCOME.
59. Describe why you or your child would benefit from receiving a scholarship.*
61. Signature:*
    I certify that all of the above information is true and correct and that all income is reported. I understand that this information is being given for the receipt of financial aid; and that Parks and Recreation staff may verify the information on the application.
62. Date:*
    Date:
Leave This Blank:


64. 1. Receive an email copy of this form.
65. Email address

    This field is not part of the form submission.

66. Submit Submit and Print

* indicates a required field