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2. Therapeutic Recreation Scholarship Application

   Please read the scholarship guidelines prior to completing this application. Complete a separate application form for each individual a minimum of two weeks in advance of the program start date. You will be notified by email of the final decision along with instructions on how to proceed with redeeming your scholarship award.

   Scholarships may be used for Therapeutic Recreation programs, series or special events and cannot be used to purchase equipment or exchanged for cash. For more information or for question, contact TherapeuticRec@CRgov.com or 303-814-7459.

4. First Name*
5. Last Name*
7. Date of birth*
   Date of birth
8. Parent / Guardian Name*
10. Mailing Address*
12. City*
13. State*
14. Zip*
16. Phone Number*
17. Email*
21. Please give a brief statement of why you are applying for a scholarship.*
23. Program(s) requested (please be specific)*
25. Fee for program(s)*
26. Scholarship amount requested*

    1. 25% of fee amount
    2. 50% of fee amount
    3. 75% of fee amount
    4. 100% of fee amount
28. Proof of Douglas County residency*
29. Proof of other local, state or federal assistance*
Leave This Blank:


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

    This field is not part of the form submission.

33. Submit

* indicates a required field