Mother/Primary/Legal Guardian Name (MUST PUT IN BOTH FIRST AND LAST NAME): - Please put N/A in BOTH boxes if there is not one or they do not live in the this house.
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First Name
Last Name
Father/Secondary/Additional Legal Guardian Name (MUST PUT IN BOTH FIRST AND LAST NAME) - Please put N/A in BOTH boxes if there is not one or they do not live in the this house.
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First Name
Last Name
Street/Mail Address - City - State - Zip
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Primary/Best Phone number to contact you at
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(###)
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Mother/Primary/Legal Guardian Cell Phone (put 9's in all boxes if there is not one)
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(###)
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Father/Secondary/Additional Legal Guardian Cell Phone Father/Secondary/Additional Legal Guardian Cell Phone (put 9's in all boxes if there is not one)
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(###)
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Email (s)- N/A if you don't have one
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Employer phone number to verify employment if necessary (if not employed enter all 9's in all three boxes)
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(###)
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Employer phone number to verify employment if necessary (if not employed enter all 9's in all three boxes)
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(###)
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FAMILY MEMBERS: List everyone who lives at the above address, INCLUDE THOSE LISTED ABOVE! LIST NAME(S), BIRTHDAY(S), and GRADE(S) OF EVERYONE LIVING IN YOUR HOUSEHOLD. LIST ALL INCOME RECEIVED LAST MONTH (before taxes and other deductions). SEE BELOW FOR ALL INCOME THAT IS REQUIRED TO BE LISTED. If you have no income write how you support yourself and family (i.e. student loans, grants etc.) If a child is a foster child please write FOSTER next to their name. . . .
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List First Name - Last Name - Date of Birth - Gender - Grade - All Income before Taxes for the past month (see guidelines below for a list OF ALL INCOME YOU MUST LIST!)
EXAMPLE:
Joe Recreation - 7/4/1973 - M - no grade - $1500
Jane Recreation - 8/4/1972 - F - no grade - $2000
Jack Recreation - 9/4/2001 - M - 12 - $150
Jill Recreation - 10/4/2005 - F - 9th - No income
Please Read the Scholarship Guidelines
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HRC's programs and activities are largely supported by user fees. Families meeting income guidelines may be eligible for scholarship assistance for their children.
It will take 3-10 business days to process your application. Notice of approval or decline will be received via Email when filled out online.
*Scholarship applications will not be processed without all the required information.
*Income is calculated on GROSS income (before deductions from taxes, insurance premiums, dues, employee’s social security taxes, and other employee deductions.) Income includes gross income from wages, salary, commissions, self-employment, social security, pension, retirement, public assistance, alimony, child support, strike benefits, unemployment, workers' compensation, and regular contributions from people not living in the same household.
*To receive a scholarship, at least one participant in the household must be age 17 or younger, or be 18 and enrolled in the 12th grade.
*Certain activities are excluded from scholarships including but not limited to private lessons of any kind,
specialty camps, special events, etc.
*Completed scholarship paperwork must be received in our office one week prior to enrolling in any activities.
*Hays Recreation Commission may at any time require the applicant to provide proof of income, including but not limited to pay stubs, W2s, income tax returns, DSS forms, SSI forms, Social Security statements, or Unemployment statements.
*Scholarship approval is good from the date approved till December 31 of that year. You must reapply every January 1st.
*Scholarship applications will remain confidential with the Hays Recreation Commission.
*Failure to attend an activity paid for by the scholarship may result in loss of future financial assistance.
*Foster Children or children that are wards of the court may automatically qualify, speak to the office manager.
*Scholarships may not be used in conjunction with online registration. All Scholarships must be used at our
office at 1105 Canterbury Drive. For more information call 785-623-2650.
SIGNATURE:
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I certify that all of the above information is true and correct and that all income is reported. I understand that HRC officials may verify the information on the application, and deliberate misrepresentation of the information may subject me to prosecution under applicable State and Federal laws. An adult must sign the application before it can be approved.
Signature of Adult Family Member
