Don Ralls Memorial Scholarship

The Board of Directors established an annual "Don Ralls Memorial Scholarship Fund" in January of 1999 when then District Board Member Don Ralls passed away due to Cancer. Mr. Ralls served as a Board Member for six years and was known for supporting children's programs (especially youth drama).

This scholarship is available for youth and seniors of the Fair Oaks area. This program is available on a case-by-case basis. Eligible participants will received up to 80% of fees covered on one District program upon the approved completion of an application and all appropriate criteria. The benefit is limited to one scholarship per person/per registration period. Please note that funds are limited.

The District reserves the right to limit the eligibility of programs. For more information contact Fair Oaks Recreation and Park District at 916-966-1036.

Apply for the Scholarship Below!

Don Ralls Scholarship Application

Steps

1. Don Ralls Application This section is complete This section is incomplete
2. Class information This section is complete This section is incomplete

Don Ralls Application

Head of household requesting assistance
Name*
Email Address*
Address*
City*
State*
Zip Code*
Phone Number (home)*
Phone Number (cell)
Are you employeed?*
Employer
Please fill in all the information below for each household member even if they will not be registering for a class this term.
Household members name
Special Needs
Ethnicity
Birthdate
Birthdate
Gender
Information is collected to report to funders on the diversity of recipients and programs they participate in. It may be used for grants applications and to highlight the need for additional support of the program. Individual/family information is not released.
2nd Household members name
Special Needs
Ethnicity
Birthdate
Birthdate
Gender
3rd Household members name
Special Needs
Ethnicity
Birthdate
Birthdate
Gender
4th Household members name
Special Needs
Ethnicity
Birthdate
Birthdate
Gender
Income verification
You must attach paperwork which validates your income, i.e. 1040 tax form from the most recent year (plus current pay stub and child support income) or TANF/SSI Statement (no additional pay stub is required). If you have a complete lack of income, no address or other special circumstance, please describe your situation on a separate piece of paper.
PDF, jpg, png only
Notes if needed
Digital Signature*
I understand that by signing this form, that all electronic signatures are the legal equivalent of my manual/handwritten signature and I consent to be legally bound to this agreement. I further agree my signature on this document is as valid as if I signed the document in writing. This is to be used in conjunction with the use of electronic signatures on all forms regarding any and all future documentation with a signature requirement, should I elect to have signed electronically.
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Class information

Program limted to use by qualifying youth (18 years or younger), Senior Citizens ( years or older), and Access to Recreation participants.
In order to qualify, your household's monthly gross income must fall within the income limits show here. You must attach paperwork which validates your income, i.e. tax form from the most recent year (plus current pay stub) or TANF/SSI Statement (no additional pay stub is required). Please include any income received from child support as well. All adults (19 and over) in the household must provide proof of residency.
Scholarship assistance will be determined by Fair Oaks Recreation & park District Recreation Staff, on a case-by-case basis. Scholarships are based on need with one scholarship option of up to 80% off the total cost. The benefit is limited to one scholarship per person/per registration period.
Registration periods:
January-April
May-August
September-December
if there is a credit on your account, the credit will be applied first, then the scholarship amount.
One application/registration per household may be submitted per registration period, listed above. Please indicate on this form the classes your children or ATR participant wish to sign up for this registration period. Allow two weeks for approval. If you are approved, and the class has openings, you will receive notification and a receipt confirming successful registration. If you are awarded the 80% off the total cost, you will be required to pay your 20% of the program/class prior to being issued the scholarship from the Fair Oaks Recreation & Park District.
There may be a wait list for the spot in class, so please call five days prior, if you can't attend, in order to be considered for future scholarship awards.
If program funds run out during the year, it is possible the scholarship program will need to be halted, and assistance for all will be denied until funding is renewed.
Allotments are to be used solely for youth and Access to Recreation (ATR) registration (classes, leagues or camps) ONLY.
Income Limits

Family Size / Household income
1     $1,515
2     $1,800
3     $2.029
4     $2,254
5     $2,433
6     $2,612
7     $2,792
8     $2,975
Example: If three people live in your household, the gross family monthly income must be less than $2,029 in order to qualify for a Recreation scholarship. (HUD 30% of area median)
Don Ralls Scholarship Program Activity Registration Info

Please indicate the activities in which your child, you/your senior citizen or ATR participant would like to participate. After this form is submitted, you will not be able to register for anything else through the scholarship program until the next registration period. Please allow two weeks for your application to be approved and the registration confirmed.
Participant Name
Class Name
Class Dates
Class fee
Participant Name
Class Name
Class Dates
Class Fee

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

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Don Ralls Memorial Scholarship

Apply for the Scholarship Below!

Don Ralls Scholarship Application

Steps

Don Ralls Application

Class information

Income Limits

Don Ralls Scholarship Program Activity Registration Info

Contact Information

Nick Davison

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