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2. APRD RECREATION PROGRAM SCHOLARSHIP REQUEST FORM
   Scholarships are provided by a cooperative effort with the Kiwanis Noon Club and the Anacortes Parks Foundation.
4. Contact Information
6. PARTICIPANT First Name*
7. PARTICIPANT Last Name*
9. PARENT/GUARDIAN First Name*
10. PARENT/GUARDIAN Last Name*
12. Address1*
14. Address2
16. City*
17. State*
18. Zip*
20. Phone Number*
21. Parent/Guardian Email Address*
23. Name of Class or Activity Scholarship Requested for:
25. List all activities you would like a scholarship for this participant.) **Also please be specific as to what program, i.e. Youth Soccer, City League, Boys U-10, etc.*
27. Reason for financial need:*
29. Have you received a scholarship from APRD for a recreation program within the past 6 months?*

    1. Yes
    2. No
30. 
    
31. If a full scholarship is not available are you interested in a partial scholarship?

    1. Yes
    2. No
Leave This Blank:


33. 1. Receive an email copy of this form.
34. Email address

    This field is not part of the form submission.

35. Submit

* indicates a required field