12-07-2017 Parks & Rec Packet - Laserfiche WebLink

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DAVID BEHLES SCHOLARSHIP The David Behles Scholarship is awarded to Little Canada residents that may not be able to afford to participate in programs offered by the City of Little Canada. David Behles was a former youth sports coach for the City of Little Canada, coaching sport teams ranging from softball to hockey. His core belief was that every kid deserves an opportunity to play sports. With the donation that was received in memory of David Behles, the City of Little Canada is able to offer financial aid to qualifying residents for registration and program fees of youth sports. Families can receive help with the Little Canada Parks and Recreation program and registration fees if you demonstrate financial need and are a resident of Little Canada. All participants pay a minimum 20% of program fees. Please complete the form below and send it to the City of Little Canada, Attn: Parks and Recreation Department at the address listed above. A Parks and Recreation staff person regarding details of the award will contact you. All scholarship information is kept confidential. Parent/Guardian Name: _______________________________________________________________________ Participant’s Name: ____________________________________ Date of Birth: _________________________ Address: ______________________________________________________ Zip Code: __________________ Home Phone: __________________________________ Work Phone: ________________________________ Program for which scholarship is desired: ________________________________________________________ Activity Number: _____________________________________ Fee: ________________________________ Do you qualify for financial assistance?(e.g. free or reduced lunch program or public assistance): Yes No **Documentation must be provided (school district letter, WIC card, or other form) that they are on the free or reduced lunch program for the current year or other public assistance program. Additional information to support your need for a scholarship: ________________________________________ _________________________________________________________________________________________ I certify that all of the above information is true and correct. I understand that school officials may verify the information on this application. Signature Date For Office Use Only Approved:_______Amount Awarded:__________________________________($200 annual maximum per participant) Denied:________ Reason:_________________________________________________________________________