Program Scholarship Applications ,,;,oValley
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Parks and Recreation
Scholarship Application
Participant's Full Name:
Participant's Grade in School:
Name and Grade Level of Participant's Sibling who attends school (ifparticipant is under school age):
Participant's (or sibling's) School:
School District of participant's (or sibling's school) school:
Full Name of parent or guardian:
Mailing Address:
Daytime Phone:
Program this scholarship will be applied to:
Evening Phone:
city:
For School District Use Only
Please indicate below if the above mentioned student qualifies
for the Free or Reduced Lunch Program by circling the appropriate
response and signing.
Yes -child does qualify No -child does not qualify
State: Zip Code:
Email address:
Total Fee for program:
For Internal Parks and Recreation Use Only
Total Scholarship Awarded:
Signature:
Code:
Signature & Date
Policy Agreement: At this time it is the policy of the City of Spokane Valley Parks and Recreation Department to enable children of lower
income families to participate in City recreation programs by granting limited scholarships to children who qualify for free or reduced
lunches at school. If children are below school age, their eligibility will be determined by the eligibility of an older sibling currently living in
the same household, or on a case by case basis if no other children currently reside at the same household. Eligibility for home - schooled
children and preschool children without older siblings, will be determined on a case -by -case basis. The maximum amount of the scholarship
is to be determined by the rate of the child's (or sibling's) free or reduced lunch status, up to a maximum of 50% off the total cost of the
session, and limited to one single session per child, per registration season. Free or reduced school lunch status, and therefore scholarship
eligibility, will be verified through the schools prior to awarding any scholarships. Following this determination, you will be notified of your
eligibility, and awarded scholarships will be deducted from your final invoice. In the meantime, please pay 50% of your child's fees. If a
balance remains, we will invoice you accordingly.
By signing below, I agree to this policy, and I agree to release information to the City of Spokane Valley that pertains to my child(ren)'s free
or reduced school lunch status for the purpose of investigating scholarship eligibility. I further agree to pay any remaining registration
balance the City of Spokane Valley may determine I need to pay, after verifying my family's eligibility for scholarship.
Parent/Guardian Signature:
Director's Approval: Date:
Date:
Return this form with your registration to: Spokane Valley Parks and Recreation, 2426 N. Discovery Place, Spokane Valley, WA 99216