Parks Recreation Scholarship

How many individuals UNDER 18 YEARS OF AGE live in your household? *

How many individuals 18 YEARS OF AGE OR OLDER live in your household? *

Full Name *

Address *

Email Address *

Phone Number *

Please add each child in your household for whom you are submitting an application. Include both first and last name for each child (e.g. John Doe). *

What is your employment status? *

What is your annual total gross income from employment? *

How much monetary child support or alimony do you receive annually, if any? (optional) *

How much local, state, or federal assistance (e.g. child care assistance) do you receive annually, if any? (optional) *

What Income Documentation You Will Provide *

Please upload documentation showing Monroe County residency (e.g. current lease, utility bill). *

I understand that the information I provided will be kept confidential. The information provided is true and complete to the best of my knowledge and belief. I consent to the disclosure of such information for purposes of verification related to this application. I understand that any willful misstatement of material fact will be grounds for disqualification. *

I understand that this application is for the scholarship, and that the application for the program itself is separate. I understand that the scholarship does not cover the full amount of the program, and I agree to pay any outstanding balances after the scholarship amount has been applied. *