Senior Living Membership Scholarship Application

To help seniors pay for their membership at the Boardman Park and Recreation Center and promote healthy living.
*Scholarships available while funds last.*

First & Last Name (required)

Phone (required)

Email (required)

Address Line 1 (required)

Address Line 2

City (required)

State (required)

Zip (required)

Household Assistance Received (Check all that apply) (required)

Snap

OR Health Plan

SSA/SSI Benefits

Gross Yearly Income (required)

Gross Monthly Income (required)

I certify that the above information is true and correct and that all household income is reported. I will notify Boardman Park & Recreation District of any changes. I am a resident of Boardman. I understand that providing false or incomplete information to the district will result in the immediate loss of financial assistant. (required)

I Agree with the above statement.

Date (required)

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