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__/4pesourre <br />700 E. Mountain View Ave. Suite 501 Ellensburg, WA 98926 (P) 509.925.1448 110 Pennsylvania Ave. Cle Elum, WA 98922 (P) 509.674.2375 (F) 509.674.5187 <br />EXHIBIT A <br />Youth Recreation Scholarship Program Guidelines <br />PURPOSE <br />The program's purpose is to mitigate the effects of poverty and other situations that place a child's social and <br />emotional development at risk. The Youth Recreation Scholarship is intended to assist children age 0-18 to <br />participate in after-school or extracurricular activities. <br />ELIGIBILITY <br />• Lower Kittitas County residents (zip codes 98926, 98934, 98950, 98946) must have family income at or <br />below 60% of Area Median Income (see chart on application). <br />• Children in foster care qualify with proof of placement in a licensed foster home regardless of income. <br />ADMINISTRATION <br />HopeSource will administer the disbursement of the Youth Recreation Scholarship funds on behalf of Kittitas <br />County. <br />APPLICATION <br />Families interested in applying for a Youth Recreation Scholarship will submit their application to HopeSource. <br />The application shall include the following: <br />1. Application form (includes address, contact information and information about the activity the child is <br />participating in) <br />2. Registration form or other proof of activity cost <br />3. Proof of one month's income and names, birth dates and Social Security numbers for each family member (OR <br />information on file with HopeSource current within the last year). <br />SCHOLARSHIP-FUNDED ACTIVffiES <br />Scholarships can help pay for music lessons, art classes, dance, gymnastics, swim lessons, sports leagues, day <br />camps and more for children age 0-18. The scholarship may also be used for equipment for a specific activity if <br />the equipment is necessary in order to participate in that activity (for example, soccer cleats for a soccer league). <br />PAYMENT INFORMATION/RESTRICTIONS <br />• Lower County scholarships: 75% per application request, not to exceed $75. Limit of $125 per child per <br />calendar year. <br />Each parent/guardian should anticipate making a monetary contribution to the activity. HopeSource will send <br />payment directly to the organization responsible for the activity. The organization must be able to provide a W-9 <br />form to HopeSource to receive payment. <br />APPROVAL <br />Upon final approval for funding, an award letter will be issued. We encourage combined resources to help meet <br />the financial need for the child. <br />3/30/2018