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HopeS OUTCC 700 E. Mountain View Ave. Suite 501 Ellensburg, WA 98926 P: 509.925.1448 F:509.925.1.2O4 www. hopesource. us Exhibit "A" Youth Recreation Scholarship Program Guidelines Our mission is to mitigate the effects of poverty and other situations that place a child's social and emotional development at risk. The Youth Recreation Scholarship is intended to help children participate in after-school or extracurricular activities, ELIGIBILITY. Lower Kiftitas County residents (zip codes 98926, 98934,98950, 98946) must have family income at or below 600lo of Area Median Income (see chart on application).. Upper Kittitas County residents (zip codes 98922, 98925,98940, 98941 and 98943) must have family income at or below 80o/o of Area Median Income (see chart on application).. Children in foster care qualifu with proof of placement in a licensed foster home regardless of income. ADMINISTRATION HopeSource will administer the disbursement of the Youth Recreation Scholarship funds on behalf of Kittitas County, the Law and Justice Council, City of Ellensburg, United Way and the Shoemaker Foundation. APPLICATION Families interested in applying for a Youth Recreation Scholarship will submit their application to HopeSource either online or on paper. The application shall include the following: 1. Application form (includes address, contact information and information about the activity the child is participating in) 2. Registration form or other proof of activity cost 3. If Lower County resident, proof of one month's income and names, birth dates and Social Security numbers for each family member (OR information on file with HopeSource current within the last year). SCHOLARSHIP-FUN DED ACTIVITIES Scholarships can help pay for music lessons, art classes, dance, gymnastics, swim lessons, sports leagues, day camps and more for children age 0-18. The scholarship may also be used for equipment for a specific activity if the equipment is necessary in order to participate in that activity (for example, soccer cleats for a soccer league). PAYM E NT I N FORMATIO N/RESTRICTIO NS. Lower County scholarships= 75o/o per application request, not to exceed $75, Limit of $125 per child per calendar year.. Upper County scholarships: Up to $100 per activity per child and up to $100 for purchase of equipment. Parents have $10 co-pay, Scholarships limited per calendar year to $1,000 per household or $400 per child. Each parent/guardian should anticipate making a monetary contribution to the activity. HopeSource will send payment directly to the organization responsible for the activity. The organization must be able to provide a W-9 form to HopeSource to receive payment. APPROVAL Upon flnal approval for funding, an award letter will be issued, We encourage combined resources to help meet the financial need for the child. 6lrsl202t