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PUBLIC HEALTH and SOCIAL SERVICES
Specialized Recreation Scholarship Application
Complete
Annual Participant Forms
before completing the scholarship form. Do not self-register for activities you wish to use scholarship funds. This will be handled by Specialized Recreation staff.
Scholarships are limited to a maximum of $60 each month.
You must re-apply each month.
Scholarships can be used on any program(s). Any remaining funds do not carry over to the next quarter.
You must pay the balance of fees for your program(s) when you receive your invoice.
Our standard cancellation policy applies: You must notify our office 3 working days before the activity begins if you will not be attending.
Scholarship fees cannot be transferred to other programs or participants.
IMPORTANT:
If you received a scholarship and you do not attend registered activity, you will be responsible for full payment of the program fees.
Call
867-2679
if you have questions.
Scholarships are subject to the availability of funds.
Participant Name:
*
Phone Number
*
E-mail Address
*
Activity 1 - I would like to use $60 scholarship funds for (activity name, date, and cost):
Activity:
*
List all scheduled dates of activity that you are requesting:
*
Cost of activity:
*
If you would like to use scholarship funds for more than one activity, include additional events below: Activity 2
Activity (2):
Date(s) of activity:
Cost of activity:
Activity (3):
Date(s) of activity:
Cost of activity:
Add additional activity information here, if needed:
Thank you to the PARC Foundation for donating Recreation Scholarship funds!
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412 Lilly Rd. N.E., Olympia, Washington 98506-5132
(360) 867-2679 FAX (833) 499-1806 TTY/WA Relay 711
www.thurstoncountywa.gov/phss