Scholarship Application

Download / Print Scholarship Application

CVPRD Scholarship Application Online

Name (required)

Parent/Guardian Name (if under 18)

Address (required)

City (required)

State (required)

Zip (required)

Phone (required)

Email (required)

Sex (required)

Male

Female

Age (required)

Program Applying for (required)

Fee (required)

How will you or your child benefit from the recreation activity you're applying to receive scholarship funds for? (required)

Applicants must be a District resident and provide either a valid driver's license or other picture ID indicating residency in Dacono, Frederick, or Firestone. Show proof of participation in an assistance program such as SNAP (EBT cards), Aid to the Needy and Disabled (AND), Child Care Assistance Program (CCAP), foster care, free or reduced lunch, Low Income Home Energy Assistance Program (LIHEAP), Medicaid, Medicare Savings Program, Old Age Pension (OAP), Supplementary Security Income/Social Security Disability Income, or Temporary Assistance for Needy Families (TANF). If you are not on a qualifying assistance program but your income is within federal low-income guidelines, please submit a copy of your most recent 1040 tax return with your social security number blacked out. If you are unable to upload documents, you may present your documentation in person at any CVPRD location.

Upload required documentation here

Your Signature (required)

Confirm e-Signature

Review Electronic Records and Signatures Policy (required)

Read our Electronic Record and Signature Disclosure

I agree to use electronic records and signatures

Date Signed

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