FEDERAL WAY COMMUNITY CENTER FEE REDUCTION APPLICATION

Thank you for your interest in the City of Federal Way Parks Department and Federal Way Community Center (FWCC Households* that meet certain income criteria are eligible to receive a 25% fee reduction on recreation programming and FWCC memberships and programs. You can easily determine if your Household qualifies and ensure that you submit a com- plete application by carefully reviewing the Household Definition, Application Process, and Income Eligibility guidelines below.

Household Definition: For the purposes of the Federal Way Community Center, household is defined as all persons related or unrelated residing at the same address who share living expenses.

APPLICATION PROCESS

1. Fill out application in its entirety.

2.Select a primary applicant and list all additional members of the Household. Previous year’s W-2 form required. If your Household did not file taxes, or if an individual(s) was not claimed, proof of residency is required for each person not included on the W-2. Acceptable sources include: Current WA State ID, any government/state agency form.

3 List the monthly total for each source of income/assistance received for the entire Household. Proof of in come/assistance is required for each source listed. Acceptable sources include: Tax return (W-2 from previous year only), pay stubs, any government/state agency form.

4. Applications will be reviewed within 10 business days of receipt. Applications with with missing information will be held for a maximum of 60 days before being denied. Applicants will be notified of outcome via phone and/or email (mail if no email address is provided

5. Approved Households may use fee reduction for one year from approval date.

6. Fee reduction is not retroactive and cannot be applied toward previous registrations and/or membership payments.

Income Eligibility: If the Household’s total gross income is the same/less than amount shown in the table below, then any member of that Household is eligible to receive fee reduction under the stated guidelines. Income includes wages, social security, pension, unemployment, welfare, alimony, child support, and any other source of income/assistance. If foster children are included, you must also include the foster child’s personal income.

Applicant Name*

First NameLast Name

Primary Applicant Birthdate*

Date

Household Address*

Address

Street Address Line 2

CityState / Province

Zip

Telephone*

Format: (000) 000-0000.

Email*

example@example.com

If applicable, list all ADDITIONAL members of your Household:

Rows	First name	Last name	Birthdate	Gender
Additional Member 1
Additional Member 2
Additional Member 3
Additional Member 4
Additional Member 5
Additional Member 6
Additional Member 7

List all forms of income and assistance for the Household (totals should represent combined monthly amount):*

Rows	$$$
Wages
Unemployement
Social Security
Food Assistance / EBT
Alimony
Child Support
Other
TOTAL

Please upload ALL supporting documentation for income and assistance for Household.*

Allowed File Types: pdf, doc, docx, zip, jpg, jpeg, png

I certify that all required information is present and accurate. I understand that this information is being given for the receipt of fee reduction; that City officials may verify the information on this application; and that deliberate misrepresentation of the information my subject me to cancellation of benefits. I understand and agree that if the City receives NSF payment or if there is any delinquency on my account all services including membership for the FWCC will be cancelled and I will be expected to pay all past due fees.

Signature*

Date