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 HMP-TR, which offers 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. Be Able to provide proof that you are a Rockford Park District resident to be eligible for assistance.

3. Provide proof of guardianship.

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

For youth 18 and underFor individuals with Disability related needs in therapeutic recreation programsBoth

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)*

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Proof of Guardianship (provide one)*

State of Illinois Medical Card- If using a State of Illinois Medical Card as proof of guardianship, the guardian’s and participant's name must be listed on the cardBirth Certificate (Please upload a birth certificate for each participant)Student Record (Please upload student record for each participant)Most Recent Tax Return ( Participant must be listed as dependent)Other legal document proving guardianshipFoster Care / DCFS 906 Placement form
Please upload proof of Guardianship*

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Proof of Income*

Current Link/SNAP statement-(automatically approved for 50% discount)A letter dated within the last 30 days from State of Illinois - Department of Human Services confirming cash/TANF benefits-(automatically approved for 50% discount)One month of paycheck stubsUnemployment CompensationChild SupportSocial Security/Disability Income
Automatically approved for 50% discount

Foster Care / DCFS 906 Placement form
Federal Tax Return*

Most Recent Tax Return
Please upload proof of income *

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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*

Clear
Please verify that you are human*
Should be Empty:

Help Me Play Scholarship Program Application