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SCHOLARSHIP APPLICATION <br />The information requested below will be used to determine if you qualify for scholarship assistance. These scholarships are available <br />for designated Arden Hills Recreation programs only. If you do not provide the information, you may not be considered for the <br />scholarship. The information you provide and the fact that you applied for a scholarship will be kept confidential. This information <br />will not be made available to any other people of governmental agencies, unless you so request. <br />ONLY CITY OF ARDEN HILLS RESIDENTS ARE ELIGIBLE TO RECEIVE THIS ASSISTANCE. <br />Please answer all questions on this form: <br />NAME OF APPLICANT (PARTICIPANT): <br />IF CHILD, PLEASE GIVE PARENT(S) NAME(S): <br />HOME ADDRESS: <br />CITY: ZIP CODE: <br />HOME PHONE: ( ) WORK PHONE: ( ) <br />TOTAL MONTHLY HOUSEHOLD INCOME (TAKE-HOME) $ <br />NUMBER OF PEOPLE IN THE HOUSEHOLD: <br />OTHER INFORMATION SUPPORTING YOUR REQUEST FOR SCHOLARSHIP <br />PROGRAM FOR WHICH SCHOLARSHIP IS REQUESTED: <br />PROGRAM CODE #: PROGRAM FEE: $ <br />HOW MUCH, IF ANY, ARE YOU ABLE TO CONTRIBUTE? $ <br />i::....... rv.:...... N.........f..r ....f :r:r...n•r.•,.,.. r. r.:..........................:r........:........»......: ...: •.:: •..: v:: x::: •.�:::::: •::::...:.. .. ........................... :.....: :...::.::::i::.r::;:•ryi;::::: •iw:.. ...... �.{,.:::::�:.::::::::..........F..:..........:...r.....: r.4: Y:: }:: iiiii: rr::::::: :. ......: f................. .... .....:.......... . ..:......:........:... . ...:.. . : .: ::.. .r». rr ............... r...... .. .: <br />•.. :: ..:..::. ... .. ::.. ..::: :.. :. ::: ::... ..: ..:.. ..:::.::::::: :x• ;... ::.... • ......:.•,...:::::`'i:.'..: �,..::.................:.;::.fir:,,;..:....; /.::..:.::;..;�. :. ..::: :! <br />:: ,: ::i::• :u •.: x.: :.. '••'• :f::: :::: :.. :: cy:a • .::<t;;rr;: •: •.: , :'•: t:<;:: '•::: '• '•.:: 't ::: , ,. ...: •. :•; •. r.:: .. r•: :. '•,:;: •.» :• :' ::. �:: y::•: :.: ::• <br />•.'".�',,'•�•.'•,'.••'•,�'�>:''••a�'•I•:•�`'.•t�•.•,•�,r:':."ra�"�::::•���''��•''.��•''.•''�''�4ii�'�:i.'ifi':l•.'••..�"'•�`:�'•`'�:;i::: ::::. <br />...:...:::::.:.::.•,... :. r:...: .:.....::.........:...::.....:...:............:::: r::::r::: r::.:....:::: r..::�:::::r:: rr:::r: •:::::: •: •: r:.:: :::::.,.:.• :.• f::r:..:...�: •: �.:::::::::::::::f .::...0 <br />J <br />I CERTIFY THAT ALL OF THE ABOVE INFORMATION IS CORRECT AND THAT ALL INCOME IS REPORTED. <br />SIGNATURE OF PARENT OR ADULT HOUSEHOLD MEMBER) (DATE) <br />RETURN COMPLETED APPLICATION, ALONG WITH REGISTRATION FORM(S) AND CHECK (IF APPLICABLE) <br />TO: Arden Hills Parks and Recreation. <br />