YOUTH ASSISTANCE PROGRAM APPLICATIONFunded by the Culture, Parks, and Recreation DepartmentApplicant/Parent Name(Required) First Last Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home PhoneCell Phone(Required)Email(Required) Date of Birth Month Day YearPlease list family members who will be utilizing this program:(Required)Name (first and last)Date of BirthAge$150 Scholarship will be used for which class or program?ADA Classified Add RemovePROOF OF ELIGIBILITY: One of the following’s most recent Benefit Letter(Required) (SNAP) Supplemental Nutrition Assistance Program (WIC) Special Supplemental Nutrition Program for Women, Infants, and Children (CCCAP) The Colorado Child Care Assistance ProgramUpload your proof of eligibility document(Required)Max. file size: 400 MB.Applicant’s Signature(Required)Date of Submission(Required) Month Day YearPlease share how this scholarship benefits you and your family(Required)OFFICE USE ONLY Received by Front Desk: Staff Initial ____________ Date ____________ Approved/ Denied ____________ Entered in RecTrac System ____________ Notes: Please call one of the locations below three (3) working days after submittal to find out if the application has been approved. -Greeley Recreation Center, 970-350-9400; -Rodarte Community Center, 970-350-9430; -Family FunPlex, 970-350-9401.Youth Assistance ProgramContact 970-336-4206 for more information.The Youth Assistance Program is available for families that have financial hardship and would still like to have the opportunity for their child to participate in City of Greeley Recreation Programs. The Greeley Culture, Parks and Recreation Department raises money through a variety of sponsorships and donations to the Youth Assistance Program. If there are funds available, we will try to accommodate all requests.Qualification Process and Information:Participants must be Greeley residents (Non-Greeley Weld County residents will be accepted on a first-come, first-served basis) and must provide a most recent benefit letter of qualification from (SNAP) the Supplemental Nutrition Assistance Program, (WIC) Special Supplemental Nutrition Program for Women, Infants, and Children, or (CCCAP) the Colorado Child Care Assistance Program.Once qualification is confirmed, each child will receive a $150.00 scholarship. Each participant can utilize this money towards program registration costs. In addition, camps, clinics, recreation jerseys, and punch passes are also included.The Youth Assistance Scholarship will cover only 70% cost for any program over $100.00. The remaining 30% balance will need to be paid out of pocket by the participant at the time of registration.The Youth Assistance Program scholarship program will expire on December 31st.The Youth Assistance Program cannot be used towards any membership, pool pass or daily fee.The AIR Assistance Program is for participants that may not qualify for Youth Assistance and have a disability as defined by the Americans with Disabilities Act (“ADA”).
