"Financial Assistance Eligibility Application Form" - Easton, Massachusetts

Financial Assistance Eligibility Application Form is a legal document that was released by the Recreation Department - Town of Easton, Massachusetts - a government authority operating within Massachusetts. The form may be used strictly within Easton.

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Easton Recreation Department
Financial Assistance Policy
Discounted registration fees may be available to those who qualify, on a sliding scale,
based upon availability of funds and Federal Income Guidelines.
Please fill out the Financial Assistance Eligibility Application Form. Information on the
application is confidential and will be used only for the purpose of determining eligibility
for the financial assistance program. This application is kept on file for one year, and a
new application must be submitted if financial need continues the following year.
The Financial Assistance Eligibility Application Form is a “request form” only, not a
confirmation of registration. The Recreation Department will review all applications and
determine the availability of funds prior to the approval of each registration request.
Upon approval, the Recreation Department will confirm registration with the applicant.
Eligible individuals and families must follow the regular registration process.
Registration deadlines will apply. Registration for many programs is limited and
eligibility for financial assistance does not guarantee enrollment in a program.
Services exempt from financial assistance include:
Blue Hills ski or snowboard season pass
Equipment Rentals (skis, skates, etc.)
Daily admissions (town pool)
Birthday parties at the town pool
Ticket Sales (group trips, field trips)
Also, some programs are run by outside contractors. Discounts for these programs will
vary and be dependent upon instructor fees.
This list is subject to change at the discretion of the
Easton Recreation Department.
Easton Recreation Department
Financial Assistance Policy
Discounted registration fees may be available to those who qualify, on a sliding scale,
based upon availability of funds and Federal Income Guidelines.
Please fill out the Financial Assistance Eligibility Application Form. Information on the
application is confidential and will be used only for the purpose of determining eligibility
for the financial assistance program. This application is kept on file for one year, and a
new application must be submitted if financial need continues the following year.
The Financial Assistance Eligibility Application Form is a “request form” only, not a
confirmation of registration. The Recreation Department will review all applications and
determine the availability of funds prior to the approval of each registration request.
Upon approval, the Recreation Department will confirm registration with the applicant.
Eligible individuals and families must follow the regular registration process.
Registration deadlines will apply. Registration for many programs is limited and
eligibility for financial assistance does not guarantee enrollment in a program.
Services exempt from financial assistance include:
Blue Hills ski or snowboard season pass
Equipment Rentals (skis, skates, etc.)
Daily admissions (town pool)
Birthday parties at the town pool
Ticket Sales (group trips, field trips)
Also, some programs are run by outside contractors. Discounts for these programs will
vary and be dependent upon instructor fees.
This list is subject to change at the discretion of the
Easton Recreation Department.
Easton Recreation Department
Financial Assistance Eligibility Application Form
Head of Household: _
_ Number of Household Members: _
_
Address: _
_
Telephone:
_(Home)
(Cell)
Instructions for applying:
1. List the first and last name of each person living in your household, related or not (such as grandparents, other
relatives, or friends). You must include yourself and all children living with you. Attach another sheet of paper if
needed.
2. Next to each person’s name, list each type of income received last month, and how often it was received. For
example, Earnings from work: List the gross income each person earned from work. This is not the same as
take-home pay. Gross income is the amount earned before taxes and other deductions. The amount should be
listed on your pay stub, or your boss can tell you. Next to the amount, write how often it was received (weekly,
every other week, twice a month, or monthly). In column two, list the amount each person got last month from
welfare, child support, and alimony. In column three, list pensions, retirement, and Social Security. In the All
Other Income column, include Worker’s Compensation, unemployment, strike benefits, Supplemental Security
Income (SSI), Veteran’s benefits (VA benefits), disability benefits, regular contributions from people who live in
your household, and ANY OTHER INCOME.
3. Check the no income box if the person does not have any income.
Total Household Gross Income—You must tell us how much and how often
2. Gross income and how often it was received
3.
Example: $100/monthly $100/twice a month $100/every other week $100/weekly
1. Name
Check
(List everyone
Earnings from work
Welfare, child support,
Pensions, retirement,
if NO
in household)
before deductions
alimony
Social Security
All Other Income
income
(Example)
Jane Smith
$200/weekly
$150/weekly
$100/monthly
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I certify that all information on this application is true and that all income is reported. I understand that Easton Recreation
Department reserves the right to ask for written proof to verify application information. I understand that I will be financially
responsible for the full amount of any program fees if it is subsequently determined that I do not meet the eligibility
guidelines. I also understand that the awarded discount can be changed at any time due to financial constraints of the
program and availability of funding.
Signature
Date
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