Scholarship Request

Holland Recreation is honored to offer scholarships to children in families with financial need through our Sal Perez Youth Recreation Scholarship Program. Additionally, Workforce Equipment Scholarships are available for needed program equipment. Youth Scholarships are issued based on the Federal Income Eligibility Guidelines to City of Holland Residents.

Please create an online account at the sign-in page prior to submitting a scholarship request if you are new to Holland Recreation programs.

Name

Full name of Parent or Legal Guardian

Phone Number

###-###-####

City Resident?

select

Are you a City of Holland Resident?

Home Address

City

State

Zip Code

E-mail Address

Request

select

Are you requesting a program or equipment scholarship?

Household Members

List all household members and their birth date. (Ex: John Doe - 1/1/64)

Participant Name (1)

First Child

Program Request (1)

For which recreation program(s) with season are you applying for assistance?

Participant Name (2)

Second Child

Program Request (2)

For which recreation program(s)/season are you applying for assistance?

Participant Name (3)

Third Child

Program Request (3)

For which recreation program(s) are you applying for assistance?

Participant Name (4)

Fourth Child

Program Request (4)

For which recreation program(s) are you applying for assistance?

Participant Name (5)

Fifth Child

Program Request (5)

For which recreation program(s) are you applying for assistance?

Gross Family Income

Monthly wages of all working family members before tax deductions, child support, unemployment, welfare payments, social security and scholarships.

Contact Permission?

select

Does Holland Rec have permission to contact required parties to verify this information?

Correct Information

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Do you certify that all the information you have provided is correct?

Electronic Signature

Person who prepared the application.

Date

Open the calendar popup.

Today's Date

Required Fields