Town of Milton Recreation Department
43 Bombardier Road Milton, VT 05468
Ph: (802)893-4922 I Fax (802)893-1005
kduchesneau@miltonvt.gov www.miltonvt.gov/recreation
Scholarship Request Application
Requested by: ________________________________________________________
Address: _________________________________ Milton, VT 05468 (Must be a Milton resident)
Phone: ________________ Email: ______________________________________
Participant Name: ___________________________________ Birthdate: __________
Program Name and Date(s):_______________________________________________
Program Fee: $_________________ Amount Requested: $________________
*If applying for a Scholarship, please do not register for the program(s) through Milton Recreation’s Online
Registration Portal until after a scholarship decision has been made. Thank you!
Why are you requesting a scholarship? ________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Continue on reverse if necessary)
Signature: ___________________________________________ Date: ______________
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(For office use only)
Scholarship Granted: $_______ Full Partial (circle one) Amount Due: $_______ Instructor Fee: $______
Scholarship Denied: ________ Reason for Denial: ____________________________________________
Staff Signature: ____________________________________________ Date: ______________________
Contacted Requestor (date & method): ____________________________________________________
Balance Due: $ _____________________ Date Paid: _________________ CivicRec: ________
Please note:
Scholarships considered for ages 18 and under only. Must be a Milton resident. First come,
first served while funds are available.
Further documentation may be requested by the Town of Milton Recreation Department if
deemed necessary for a decision to be made
Scholarships are limited to $200 per child/per fiscal year (July 1 – June 30).
Milton Recreation Summer Full Day Camp counts as half of publicized fee towards child’s
scholarship total.
All scholarships must be approved in writing by the Town of Milton Recreation Coordinator
at least two weeks prior to the start of the program.
The Requestor will be notified of the decision via email and/or phone as soon as possible.
All payments are made directly to the program provider from the Town of Milton.
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