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Parks & Recreation Scholarship Application Parent / Guardian Participant Mailing Address City & State Zip Primary Phone Secondary Phone E-mail Address Does the participant attend Whitefish School District? Yes No What program/activity is this scholarship for? How many days are you anticipating your child to attend this program/activity? Please complete the information below to determine eligibility for scholarship funding. Proof of income is required. Your application will not be considered without documentation. Family Size & Income 1. How many people live in your home? 2. Of those people, how many are dependents? 3. Of those people, how many do you hope to enroll in this Parks & Recreation program?* *a separate scholarship application must be submitted for each participant 4. Your gross wages before deductions per month: 5. Your gross from other income per month, including child support, alimony, disability: Add up total household Current Assistance Programs Check all that apply for current assistance you receive: Supplemental Nutrition Assistance Program (SNAP) Temporary Assistance for Needy Families (TANF) Child in Transition (CIT) Other: By signing below I attest that all information is true to my knowledge. I have attached my household’s most recently submitted wage and tax statement Printed name of Applicant: Signature of Applicant: Date: ---PAGE BREAK--- Parks & Recreation Scholarship Review FOR OFFICE USE ONLY Program requested: Cost of program: /day /session Number of days requested: Total scholarship request amount: Scholarship awarded? Yes No Scholarship percentage: Scholarship dollar amount: Applicant’s expected total payment balance: Scholarship Award emailed/mailed on by Notes: