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Parks & Recreation Fee Assistance Program Thank you for choosing the City of Redmond Parks & Recreation Department to achieve your recreation needs. Our desire is to make recreational opportunities available to all City of Redmond residents regardless of income. The City of Redmond Parks & Recreation Department offers the Fee Assistance Program to City of Redmond residents who might not otherwise be able to participate. DETAILS AND ELIGIBILITY • The Fee Assistance Program is available to eligible City of Redmond residents • Eligible residents will be required to provide proof of residency and income • Applicants who meet eligibility requirements are awarded up to a maximum of $300 per person, per year, not to exceed $1,500 per household • Funds are valid from December 1-November 30 • A new application is required to be completed every year HOW TO APPLY 1. Complete all sections of the Fee Assistance Program Application 2. Provide Proof of Income & Proof of Residency Acceptable financial documents include: your most current tax return, a current paycheck stub, DSHS check stubs or SSI statement If your income exceeds the above stated guidelines or if there have been recent changes to your income or financial situation, please briefly describe your current needs and personal circumstances on an attached sheet to accompany your application. Return to Any Community Center: The Redmond Community Center at Marymoor Village 6505 176th Ave NE Redmond, WA 98052 Please call [PHONE REDACTED] or email [EMAIL REDACTED] with questions or further assistance. The Redmond Senior Center 8703 160th Avenue NE Redmond, WA 98052 The Old Fire House Teen Center 16510 NE 79th Street Redmond, WA 98052 ---PAGE BREAK--- Household Size: Total Household Income: Fee Assistance Program Application Year: 2019 The information on this application will remain confidential, and is used for purposes to apply for a reduction in Recreation fees through the Fee Assistance Program. Please complete all sections of the below application, and submit along with proof of income. Fee Assistance Program Income Eligibility HOUSEHOLD is designed as all persons, including parents, children, grandparents, and all people related or unrelated who live in your home and share living expenses. If applying for a household with a foster child, you may include the foster child in the total household size. HOUSEHOLD INCOME is considered to be the income each household member received before taxes. This include wages, social security, pension, unemployment, welfare, child support, alimony and any other cash income. First Name Last Name Phone Address City State Zip Code Sex: M F Date of Birth Email Address Sex First Name Last Name Relationship Date of Birth M F Sex First Name Last Name Relationship Date of Birth M F Sex First Name Last Name Relationship Date of Birth M F Sex First Name Last Name Relationship Date of Birth M F Documents included with this application include: Most Recent Tax Return Most recent Paystub DSHS Statement SSI Statement Personal Story or Explanation (Other) OFFICE USE ONLY: (Income Verification) Date Received: Verified by: Approved Not Approved Exception Residency Document: Income Document: Awarded: 50% 65% 80% Notes: Household Size 1 2 3 4 5 6 7 8 50% Scholarship $56,200 $64,200 $72,250 $80,250 $86,700 $93,100 $99,550 $105,950 65% Scholarship $37,450 $42,800 $48,150 $53,500 $57,800 $62,100 $66,350 $70,650 80% Scholarship $22,500 $25,700 $28,900 $32,100 $37,414 $42,484 $48,282 $53,716 Applicant Information Other Family Members