Financial Aid Form
The Narragansett Parks and Recreation Department (NPRD) offers assistance options to ensure that no one is
turned away due to financial limitations. Financial Aid is for Narragansett Residents Only
Verification of income is required and must be submitted with this application. The following methods
are accepted:
1. Submittal of prior year Form 1040 tax return.
2. Copy of Benefits Determination Letter (for Welfare, AFDC, SSI).
Additional information may be required in order to determine the appropriate amount of financial assistance to
be awarded. (i.e. 3
rd
party reference, medical bills, etc.)
INSTRUCTIONS
1. The head of household must complete the financial assistance application.
2. Attach all necessary documents.
3. Sign and return to NPRD.
If all the proper information has been received with a signed completed application, the NPRD will process the
financial assistance request and notify the applicant within ten business days.
Narragansett Parks & Recreation Department
170 Clarke Road
Narragansett, RI 02882
(401) 782-0658
(401) 788-2553 (fax)
Financial Assistance Application
Narragansett Parks & Recreation Program Desired:________________________________________________
Head of Household:_________________________________________________________________________
Address:__________________________________________________________________________________
City:______________________________________ State:_________________ Zip:______________________
Phone (day):____________________(Evening):__________________ M:___ F:___ Date of Birth:__________
List name and date of birth of all individuals living in the same household who share living expenses (including
yourself, spouse, children, etc.)
Name DOB Name DOB
___________________________ __________ ______________________________ __________
___________________________ __________ ______________________________ __________
___________________________ __________ ______________________________ __________
Monthly Income: Total amount of monthly income before deductions (including wages, salary, public
assistance, child support, alimony, social security, unemployment compensation, TDI, worker’s compensation,
pension, or retirement income) available to support household expenses from all sources and individuals living
in the household: $__________________________________________________________________________
Additional reasons which I feel are relevant to my application:_______________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
I hereby certify that I have completed all the information requested within this application form, and that all
information supplied is true and accurate to the best of my knowledge, and that there is no misrepresentation by
omission. I further understand that this application does not constitute acceptance by the NPRD, and that I will
be notified as to whether my application for financial assistance has been approved or not.
______________ _____________________________________
Date Applicant Signature
______________ _____________________________________
Date Director or Designee Signature
FOR OFFICE USE ONLY Percentage awarded ___________________
Date
Participant
Program
Total
Fee
Fin. Assist.
Amount
Participant
Amount
click to sign
signature
click to edit
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome