9.g Discussion on Policy to Provide Recreational Program Assistance
CITY OF SCANDIA
RECREATION PROGRAM ASSISTANCE POLICY
Recreation Program Assistance
In is the intention of the City of Scandia to provide a program for those individuals that may need financial
assistance to participate in our recreation programs. This pro gram is available for Scandia residents only. It is
the policy of the City of Scandia to provide services to all residents regardless of sex, race, color, national
origin, ability, or financial status. The assistance is contingent on the availability of funds.
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 Assistance
Program Assistance will be awarded as resources allow
How much assistance can my family receive?
Each eligible family can receive up to $50 per person per year with a family maximum of $200 per
year.
A minimum co-payment of 20% will be required at the time of registration for all programs.
What programs are not eligible for Assistances?
Facility rental including room rentals and picnic shelters
Assistances are available for program fees only (special event admissions are not eligible)
CITY OF SCANDIA
PARKS AND RECREATION
APPLICATION FOR RECREATIONAL PROGRAM FINANCIAL ASSISTANCE
An adult household member must complete this application before registering for any
programs or activities to receive Program Assistance. Only one form, per family, is needed
for each calendar year. Assistance is contingent on the availability of budgeted funds. 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:____________________________________________________
Home Phone: ____________________________________________________
Alternative Phone:_________________________________________________
TOTAL HOUSEHOLD INCOME
Is your family eligible for free or reduced price school meals based on the Federal Income
Eligibility Guidelines? Yes No
Within the last 12 months has there been a financial hardship for your family?
Yes_____ No_____ If “Yes”, Explain
APPLICATION INFORMATION
Participant 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 Assistance, participants will not be registered or added to any
program rosters until your 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