Help Me Play Scholarship

Help Me Play Scholarship Program Application
Eligible participants in the Help Me Play (HMP) Scholarship Program can receive a 50% discount on Rockford Park District programs and lessons. Additionally, individuals with disability-related needs may qualify for a 50% discount exclusively for Therapeutic Recreation programs and lessons.

To apply for the Help Me Play (HMP) program, you must:

1. Apply in person at a Rockford Park District Customer Experience location or online. Please allow 3 - 5 business days for online applications to be processed. Once the application is processed and approved, an email confirmation will be sent.

2. Live within the Rockford Park District taxing area and provide proof of residency to receive assistance.

3. Provide proof of guardianship.

4. Provide income-based need.
Which Help Me Play Scholarship are you interested in?

Parent/Guardian or Adult Participant Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Phone
Please enter a valid phone number.Format: (000) 000-0000.
Home Phone
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Please list ALL household members at this address (including yourself):
Name

First NameLast Name
Birth Date

MonthDayYear
Date
Relationship
Name

First NameLast Name
Birth Date

MonthDayYear
Date
Relationship
Name

First NameLast Name
Birth Date

MonthDayYear
Date
Relationship
Name

First NameLast Name
Birth Date

MonthDayYear
Date
Relationship
Name

First NameLast Name
Birth Date

MonthDayYear
Date
Relationship
Name

First NameLast Name
Birth Date

MonthDayYear
Date
Relationship
Name

First NameLast Name
Birth Date

MonthDayYear
Date
Relationship
Name

First NameLast Name
Birth Date

MonthDayYear
Date
Relationship

Documentation Verification
To qualify for the Help Me Play Scholarship you must be a resident of Rockford, IL
Please upload photo identification to verify residency (ex. driver's license or state ID card)

Cancelof
Proof of Guardianship (provide one)
Please upload proof of Guardianship

Cancelof

Proof of Income
Automatically approved for 50% discount
Federal Tax Return
Please upload proof of income

Cancelof

Electronic Signature Consent

I declare all of the information on this form to be truthful, and I understand that my information will be kept on file as needed for documentation and records retention purposes. I understand that Park District officials may verify this information, and that deliberate misrepresentation will result in elimination from the program. By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper.
Parent/Guardian or Adult Participant Name

First NameLast Name
Parent/Guardian or Adult Participant Signature
Please verify that you are human
Should be Empty: