Meridian PAL Financial Assistance Application
FINANCIAL ASSISTANCE APPLICATION Meridian Police Activities League offers need based financial assistance to reduce activity fees to provide opportunities for youth to develop and strengthen PAL core values of Leadership, Sportsmanship, and Teamwork. Financial assistance reduces fees, it does not eliminate them. All financial assistance participants pay the base fee of $30 plus any uniform kit fees for each activity per season.
SUBMIT COMPLETE APPLICATIONS by DUE DATE TO: MERIDIAN PAL, PO BOX 157 MERIDIAN, ID 83680 or email to [email protected] Child’s Name _____________________________________ DOB __________ Activity ______________ Season ____________ Child’s Name _____________________________________ DOB __________ Activity ______________ Season ____________ Child’s Name _____________________________________ DOB __________ Activity ______________ Season ____________
Parent/Guardian ______________________________________________________ Phone____________________________ Address _____________________________________________________________ City _____________________________ State ______ Zip ______________ Email ____________________________________________________________________
TO QUALIFY FOR ASSISTANCE, PROVIDE ALL OF THE FOLLOWING DOCUMENTS AND COMPLETE ALL SECTIONS: Most Recent Tax Return (1040 pages 1 and 2) Last 2 paystubs for all income earners in household or most recent 30 days Documentation of all sources of income for most recent 30 days Letter of special circumstances, if necessary Father’s Income ___________ Mother’s Income ___________ Guardian’s Income __________ Dependent Children in Household _____
Other Monthly Assistance: SSI or SSD Unemployment Food Stamps Child Support Total Assistance
$__________ $__________ $__________ $__________ $__________
I certify that the above information is true and complete to the best of my knowledge. I agree to provide all documentation to support the information above and provide Meridian Police Activities League Inc. any additional support information if necessary. I understand that if I falsify any information on this application that I will not be eligible for assistance now and in the future. Print Name
Signature
Date
Date Rec’d ____________ Date Processed ____________ Approved _______ By _______ $ Amount Approved__________ Comments:
SUBMIT COMPLETE APPLICATIONS by DUE DATE TO: MERIDIAN PAL, PO BOX 157 MERIDIAN, ID 83680 or email to [email protected] Child’s Name _____________________________________ DOB __________ Activity ______________ Season ____________ Child’s Name _____________________________________ DOB __________ Activity ______________ Season ____________ Child’s Name _____________________________________ DOB __________ Activity ______________ Season ____________
Parent/Guardian ______________________________________________________ Phone____________________________ Address _____________________________________________________________ City _____________________________ State ______ Zip ______________ Email ____________________________________________________________________
TO QUALIFY FOR ASSISTANCE, PROVIDE ALL OF THE FOLLOWING DOCUMENTS AND COMPLETE ALL SECTIONS: Most Recent Tax Return (1040 pages 1 and 2) Last 2 paystubs for all income earners in household or most recent 30 days Documentation of all sources of income for most recent 30 days Letter of special circumstances, if necessary Father’s Income ___________ Mother’s Income ___________ Guardian’s Income __________ Dependent Children in Household _____
Other Monthly Assistance: SSI or SSD Unemployment Food Stamps Child Support Total Assistance
$__________ $__________ $__________ $__________ $__________
I certify that the above information is true and complete to the best of my knowledge. I agree to provide all documentation to support the information above and provide Meridian Police Activities League Inc. any additional support information if necessary. I understand that if I falsify any information on this application that I will not be eligible for assistance now and in the future. Print Name
Signature
Date
Date Rec’d ____________ Date Processed ____________ Approved _______ By _______ $ Amount Approved__________ Comments:
