Financial Assistance Application

Household Information

Please enter information for all people living in the household including non parent/guardian adults and infants
Questions? Reach out to the Kalamazoo Parks and Recreation office at (269) 337-8191 or email us at kzooparks@kalamazoocity.org for help with this application.
How many adults aged 18 or older live in this household?*
Name of Parent / Guardian / Adult 1*
This household member is... (select all that apply)*

Head of HouseholdCo-Head of HouseholdPerson with DisabilitiesPerson 62 years of age or olderFulltime student age 18 or over
Date of Birth*

MonthDayYear
Sex*
Ethnicity
Race
This person contributes to the total household income*

YesNo
Add another Parent / Guardian / Adult*

YesNo

Questions? Reach out to the Kalamazoo Parks and Recreation office at (269) 337-8191 or email us at kzooparks@kalamazoocity.org for help with this application.
Name of Parent / Guardian / Adult 2*
This household member is... (select all that apply)*

Head of HouseholdCo-Head of HouseholdPerson with DisabilitiesPerson 62 years of age or olderFulltime student age 18 or over
Date of Birth*

MonthDayYear
Sex*
Ethnicity
Race
This person contributes to the total household income*

YesNo
Add another Parent / Guardian / Adult*

YesNo

Questions? Reach out to the Kalamazoo Parks and Recreation office at (269) 337-8191 or email us at kzooparks@kalamazoocity.org for help with this application.
Name of Parent / Guardian / Adult 3*
This household member is... (select all that apply)*

Head of HouseholdCo-Head of HouseholdPerson with DisabilitiesPerson 62 years of age or olderFulltime student age 18 or over
Date of Birth*

MonthDayYear
Sex*
Ethnicity
Race
This person contributes to the total household income*

YesNo
Add another Parent / Guardian / Adult*

YesNo

Questions? Reach out to the Kalamazoo Parks and Recreation office at (269) 337-8191 or email us at kzooparks@kalamazoocity.org for help with this application.
Name of Parent / Guardian / Adult 4*
This household member is... (select all that apply)*

Head of HouseholdCo-Head of HouseholdPerson with DisabilitiesPerson 62 years of age or olderFulltime student age 18 or over
Date of Birth*

MonthDayYear
Sex*
Ethnicity
Race
This person contributes to the total household income*

YesNo
Add another Parent / Guardian / Adult*

YesNo

Questions? Reach out to the Kalamazoo Parks and Recreation office at (269) 337-8191 or email us at kzooparks@kalamazoocity.org for help with this application.
Name of Parent / Guardian / Adult 5*
This household member is... (select all that apply)*

Head of HouseholdCo-Head of HouseholdPerson with DisabilitiesPerson 62 years of age or olderFulltime student age 18 or over
Date of Birth*

MonthDayYear
Sex*
Ethnicity
Race
This person contributes to the total household income*

YesNo
Add another Parent / Guardian / Adult*

YesNo

Questions? Reach out to the Kalamazoo Parks and Recreation office at (269) 337-8191 or email us at kzooparks@kalamazoocity.org for help with this application.
Name of Parent / Guardian / Adult 6*
This household member is... (select all that apply)*

Head of HouseholdCo-Head of HouseholdPerson with DisabilitiesPerson 62 years of age or olderFulltime student age 18 or over
Date of Birth*

MonthDayYear
Sex*
Ethnicity
Race
This person contributes to the total household income*

YesNo

Please enter information for all children living in the household including infants
Questions? Reach out to the Kalamazoo Parks and Recreation office at (269) 337-8191 or email us at kzooparks@kalamazoocity.org for help with this application.
How many children under the age of 18 live in this household?*
Child 1 Name*
This household member is... (select all that apply)*

Person with DisabilitiesChild under the age of 18 yearsMinor under the age of 15 years
Date of Birth*

MonthDayYear
Sex*
Grade in School*
Ethnicity
Race
Programs you are applying for financial assistance*
Add another Child*

YesNo

Questions? Reach out to the Kalamazoo Parks and Recreation office at (269) 337-8191 or email us at kzooparks@kalamazoocity.org for help with this application.
Child 2 Name*
This household member is... (select all that apply)*

Person with DisabilitiesChild under the age of 18 yearsMinor under the age of 15 years
Date of Birth*

MonthDayYear
Sex*
Grade in School*
Ethnicity
Race
Programs you are applying for financial assistance*
Add another Child*

YesNo

Questions? Reach out to the Kalamazoo Parks and Recreation office at (269) 337-8191 or email us at kzooparks@kalamazoocity.org for help with this application.
Child 3 Name*
This household member is... (select all that apply)*

Person with DisabilitiesChild under the age of 18 yearsMinor under the age of 15 years
Date of Birth*

MonthDayYear
Sex*
Grade in School*
Ethnicity
Race
Programs you are applying for financial assistance*
Add another Child*

YesNo

Questions? Reach out to the Kalamazoo Parks and Recreation office at (269) 337-8191 or email us at kzooparks@kalamazoocity.org for help with this application.
Child 4 Name*
This household member is... (select all that apply)*

Person with DisabilitiesChild under the age of 18 yearsMinor under the age of 15 years
Date of Birth*

MonthDayYear
Sex*
Grade in School*
Ethnicity
Race
Programs you are applying for financial assistance*
Add another Child*

YesNo

Questions? Reach out to the Kalamazoo Parks and Recreation office at (269) 337-8191 or email us at kzooparks@kalamazoocity.org for help with this application.
Child 5 Name*
This household member is... (select all that apply)*

Person with DisabilitiesChild under the age of 18 yearsMinor under the age of 15 years
Date of Birth*

MonthDayYear
Sex*
Grade in School*
Ethnicity
Race
Programs you are applying for financial assistance*
Add another Child*

YesNo

Questions? Reach out to the Kalamazoo Parks and Recreation office at (269) 337-8191 or email us at kzooparks@kalamazoocity.org for help with this application.
Child 6 Name*
This household member is... (select all that apply)*

Person with DisabilitiesChild under the age of 18 yearsMinor under the age of 15 years
Date of Birth*

MonthDayYear
Sex*
Grade in School*
Ethnicity
Race
Programs you are applying for financial assistance*
Add another Child*

YesNo

Questions? Reach out to the Kalamazoo Parks and Recreation office at (269) 337-8191 or email us at kzooparks@kalamazoocity.org for help with this application.
Child 7 Name*
This household member is... (select all that apply)*

Person with DisabilitiesChild under the age of 18 yearsMinor under the age of 15 years
Date of Birth*

MonthDayYear
Sex*
Grade in School*
Ethnicity
Race
Programs you are applying for financial assistance*
Add another Child*

YesNo

Questions? Reach out to the Kalamazoo Parks and Recreation office at (269) 337-8191 or email us at kzooparks@kalamazoocity.org for help with this application.
Child 8 Name*
This household member is... (select all that apply)*

Person with DisabilitiesChild under the age of 18 yearsMinor under the age of 15 years
Date of Birth*

MonthDayYear
Sex*
Grade in School*
Ethnicity
Race
Programs you are applying for financial assistance*
Add another Child*

YesNo

Questions? Reach out to the Kalamazoo Parks and Recreation office at (269) 337-8191 or email us at kzooparks@kalamazoocity.org for help with this application.
Child 9 Name*
This household member is... (select all that apply)*

Person with DisabilitiesChild under the age of 18 yearsMinor under the age of 15 years
Date of Birth*

MonthDayYear
Sex*
Grade in School*
Ethnicity
Race
Programs you are applying for financial assistance*
Add another Child*

YesNo

Questions? Reach out to the Kalamazoo Parks and Recreation office at (269) 337-8191 or email us at kzooparks@kalamazoocity.org for help with this application.
Child 10 Name*
This household member is... (select all that apply)*

Person with DisabilitiesChild under the age of 18 yearsMinor under the age of 15 years
Date of Birth*

MonthDayYear
Sex*
Grade in School*
Ethnicity
Race
Programs you are applying for financial assistance*

Required Documents

Attach copies of all applicable documents for submission to the City of Kalamazoo Parks & Recreation Office at 251 Mills Street, Kalamazoo MI 49048. Financial assistance will be granted on the basis of financial need within the available resources of the department. The City reserves the right to refuse assistance to any applicant. To apply for 50% or 100% financial assistance, provide the following documents:
Valid proof of City of Kalamazoo Residency*

Valid Proof of residency includes a Valid Michigan Driver's License or ID
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Income Verification*

Acceptable income verification documents include Tax documentation (e.g. W2s and 1099s) and/or proof of participation in Michigan Women, Infants, and Children (WIC), Child Development and Care (CDC), or Food Assistance Program (FAP) programs. Additional documents may be acceptable. Please reach out to kzooparks@kalamazoocity.org with questions.
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Valid proof of City of Kalamazoo Residency

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Self Certification of Annual Income By Beneficiary Form

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THIS APPLICATION IS VALID JANUARY 1ST THROUGH DECEMBER 31ST AND MUST BE RENEWED ANNUALLY .

Please allow up to 5 days for processing once all documents are returned. You are not able to register using financial assistance before your application is processed.

You will be notified when your application is processed via telephone or the email you provided on the application form.

Financial assistance will be available on a first come, first serve, per program basis per child, per year until all scholarship funds provided to the Parks & Recreation Department are exhausted. If all financial assistance funds are expended for the year, registration for Parks & Recreation programs will be charged at 100% of the cost of the program.
WARNING: The information provided on this form is subject to verification by HUD at any time, and Title 18, Section 1001 of the U.S. Code states that a person is guilty of a felony and assistance can be terminated for knowingly and willingly making a fa lse or fraudulent statement to a department of the United States Government.
Certification:
I/we certify that this information is complete and accurate. I/we agree to provide, upon request, documentation on all income sources to the HUD Grantee/Program Administrator.
Parent / Guardian / Adult Signature 1*

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Parent / Guardian / Adult Signature 2*

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Parent / Guardian / Adult Signature 3*

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Parent / Guardian / Adult Signature 4*

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Parent / Guardian / Adult Signature 5*

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Parent / Guardian / Adult Signature 6*

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Questions? Reach out to the Kalamazoo Parks and Recreation office at (269) 337-8191 or email us at kzooparks@kalamazoocity.org for help with this application.
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Financial Assistance Application

Household Information

Please enter information for all children living in the household including infants

Required Documents