2. Farmington Parks and Recreation Youth Scholarship Application Form.

   
   

   Please complete all information. We reserve the right to verify all information contained on this form.

   
   

   If you have any questions, please contact Emilee Shearer at EShearer@FarmingtonMN.gov or call 651-280-6854.

4. Applicant's Name:*
5. Date:*
7. Address:*
9. City:*
10. Zip:*
12. Email:*
13. Phone Number:*
15. List number of family members, including parent(s), living in household:*
17. Name, ages, grades of children to receive scholarship funds and programs requested for said funding:*
19. Total cost of the programs:*
20. How much of the total cost are you able to pay?*
22. Total amount of scholarship funding you are requesting?*
24. Applicants requesting scholarship funding must meet certain income limits. All applicants must show proof of income by providing one of the following documents:*

    1. Most recent monthly AFDC or TANF payment stub.
    2. A verification letter from a public or private school that states that the applicant qualifies for the Federal Government's Free or Reduced Hot Lunch Program.
    3. A verification letter from the Dakota County Family Services Department that states that the applicant qualifies for scholarship funding based on the income limits found in the Youth Scholarship Program packet.
    4. The most recent copy of the family's Federal Income Tax Form.
26. Please upload the proof of income materials that was selected above:
28. NOTICE:

    The application period is for the season & year in which the program begins. Programs that carry over to a new year will be charged against the year in which the application was made. A new application form must be completed each time a scholarship is requested for a program in order to verify that the applicant meets the current income guidelines for the scholarship program. Scholarship funding may not be available for all classes or programs. Please allow a period of at least five (5) business days to determine scholarship eligibility.

30. Acknowledgement of Correct Information

    I acknowledge that the information contained on this application is accurate and correct. I hereby give permission to the Farmington Parks and Recreation Department to verify this information. I understand that if any information on this application form is found to be incorrect, my privileges of applying for scholarship funding could be revoked.

32. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
34. Electronic Signature
Leave This Blank:


36. 1. Receive an email copy of this form.
37. Email address

    This field is not part of the form submission.

38. Submit

* indicates a required field