Fee Assistance Program Application






Section 1: 

List dependents living with you (proof of dependency is required):

Full Name Birthdate Relationship Male/Female School Grade
1
2
3
4
5

Section 2: 

Please refer to the Skokie Park District Program Guide for specific information.
Requesting fee assistance for (must be your dependent):

Participant's Name Activity/Camp Name Activity/Camp # Fee
1
2
3
4
5
6

IMPORTANT Please read the General Information Guidelines carefully. A copy of the past year's Federal Income Tax 1040 form (with W2s and all supporting schedules) for all ADULTS living in your household must be submitted with your application.


Section 3: 

Please review the following and list any information that pertains to your household:

B. Do you RECEIVE any of the following?

$ Amount
Child Support
ADC/Public Aid
Food Stamps
SSI
Pension
Unemployment
Rental Income
Family Support

Section 4: 

To complete the application process, each applicant must agree to the terms below:

I/We have been advised and understand that:

  • All information submitted is confidential and is not a matter of public record of the Skokie Park District.
  • All information provided on this form must be true and accurate.
  • All requests for fee assistance will be evaluated and approved by the Fee Assistance Administrator.
  • All fee assistance is legally recoverable if awarded on the basis of false information supplied by the applicant and will nullify your request for any future fee assistance. 
  • This applicant's household account must be current. Any default on an outstanding balance will disqualify the applicant from fee assistance now and in the future.
  • Further information may be required before action on this application is taken.
  • All requests are contingent upon availability of space within programs. 
  • Applicant(s) will be notified as soon as practicable as to the disposition of this application.

 

 

CLICK THE SUBMIT BUTTON BELOW TO COMPLETE YOUR REQUEST.

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