3.f Discussion on policy to provide financial assistance for recreation programsDRAFT 2 DRAFT 2 DRAFT 2 DRAFT 2 DRAFT 2
CITY OF SCANDIA
14727 209th Street, Scandia MN 55073
PARKS AND RECREATION
Recreation Program Scholarships
The City of Scandia provides a program for those individuals that may need financial assistance to participate
in our recreation programs. This program is available for Scandia residents only. All information submitted in
application for financial assistance will be held confidential by the City.
Who is eligible?
All applicants must be residents of the City of Scandia
Residents of all ages
Applicants who currently have outstanding balances with the City of Scandia are not eligible for
Program Scholarships
How much assistance can a family (including single adults) receive?
Scholarships granted reduce the program fees by 2/3 and require 1/3 of the program fee be paid
for the program(s) requested.
Each eligible family (single adult) can receive up to $50 per person per year with a family maximum
of $200 per year.
The 1/3 co-payment will be required at the time of registration for all programs.
What programs are not eligible for Scholarships?
Facility rental including room rentals and picnic shelters
Scholarships are available for program fees only (special event admissions are not eligible)
Program Scholarships will be awarded as resources allow
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CITY OF SCANDIA
PARKS AND RECREATION
RECREATION PROGRAMS SCHOLARSHIP - 2019
An adult household member must complete this application before registering for any
programs or activities to receive Program Scholarship. Only one form, per family, is needed
for each calendar year. Scholarships are contingent upon scholarship fund balance. All
information submitted will remain confidential.
Submit completed form to: City of Scandia, 14727 209th Street, Scandia MN 55073
PARTICIPANT INFORMATION
Adult Applicant Name:____________________________________________
Address: ________________________________________________________
City/State/Zip:____________________________________________________
Phone: ____________________________________________________
Email Address:_________________________________________________
TOTAL HOUSEHOLD INCOME
Is your family currently on any form of public assistance? Yes No
Indicated number of persons living in your household? 1 2 3 4 5+
Annual Household Income: $ __________________ (Annual Household Income includes:
wages, tips, social security, public assistance, interest, etc.)
Basis for request of Program Scholarship:
__________________________________________________________________
__________________________________________________________________
Within the last 12 months has there been a financial hardship for your family?
Yes_____ No_____ If “Yes”, Explain
____________________________________________________________________________
____________________________________________________________________________
APPLICATION INFORMATION
Participant’s Name Date of Birth
I attest that to the best of my knowledge all of the information provided on this form is
current and correct:
Parent, Guardian, or Adult Participant Signature
Date:
Upon approval of Program Scholarship, participants will not be registered or added to any
program rosters until your 1/3 portion of the program fee is received.
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FOR OFFICE USE ONLY
Eligibility Determination:
Approved Denied
If denied, indicate reason:
Comments:
City of Scandia Staff Signature/Title Date