CC Resolution 13159 - Modify the City of Campbell Policy Section 18 Financial Assistance Program Policy RESOLUTION NO. 13159
A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF CAMPBELL TO MODIFY THE
CITY OF CAMPBELL COUNCIL POLICY SECTION 18 FINANCIAL ASSISTANCE
PROGRAM POLICY.
WHEREAS, the Financial Assistance Program Policy was established to provide access to
fee-based recreation programs and services to financially qualifying youth and teens; and
WHEREAS, the program is limited due to funds solely coming from generous donations of
local service clubs, businesses, and private individuals; and
WHEREAS, the policy was updated in 2017 to increase the funding allowance; and
WHEREAS, the policy was modified in 2018 to include all students currently enrolled at
Rosemary Elementary; and
WHEREAS, many schools just outside the Campbell borders host both Campbell and San
Jose residents who utilize recreation services at the Campbell Community Center; and
WHEREAS, expanding the boundaries to include community members just outside the
Campbell border and around school sites will be more inclusive; and
WHEREAS, expanding the boundaries will provide recreation opportunities to more youth in
our community; and
WHEREAS, increasing the funding allowance will allow youth to participate in more activities;
and
NOW, THEREFORE, BE IT ,RESOLVED that the City Council of the City of Campbell
modifies the Campbell City Council Policy Section 18, Financial Assistance Program Policy.
PASSED AND ADOPTED this 21st day of May, 2024 by the following roll call vote:
AYES: Councilmembers: Bybee, Furtado, Scozzola, Lopez, Landry
NOES: Councilmembers: None
ABSENT: Councilmembers: None
APPROVED:
ATTEST: Susan M. Land , Mayor
Andrea Sande City Clerk
SECTION 18
Financial Assistance Program Policy
PURPOSE
The City of Campbell recognizes the value of participating in recreational •
programs for youth and teens. Acknowledging that the financial
circumstances of some residents may impose a barrier to youth and teens
in accessing fee based Recreation & Community Services programs and
in an effort to make its recreational programs and activities available to the
widest range of residents, the City of Campbell established the Financial
Assistance Program (FAP) to assist economically disadvantaged youth
and teens to enable them to participate in the Recreation & Community
Services classes,and programs. This program is made possible through
the generous donations of local service clubs, businesses and private
' individuals. To that extent, funds are limited and will be distributed on an
'as available' basis. Recipients of financial assistance are encouraged to
participate as program volunteers as appropriate to further contribute to
the program.
II. ELIGIBILITY
• The City of Campbell offers financial assistance to youth (17 years
and under) residing within the limits of Campbell, students residing in the
newly identified areas surrounding Campbell and students attending
Rosemary Elementary School for participation in the Recreation &
Community Services Department's program offerings. Proof of
residency or current enrollment at Rosemary Elementary School and
low income verification is required. Applicants must meet the
maximum gross income criteria established by the U.S Department of
Housing & Urban Development based on family size.
III. APPLICATION REQUIREMENTS
A FAP application must be completed by the youths' parent or legal
guardian. Incomplete applications will not be processed. A 'Household' is
defined as a group of related or non-related individuals living as one
economic unit and sharing living expenses. Living expenses include rent,
clothes, food, doctor bills, and utility bills. The following items are required
to be submitted along with the complete application:
One of the following acceptable proofs of income/financial are needed:
a Proof from the school district that child is eligible for free or reduced price
meals.
b. Proof that the household is receiving Food Stamps, Cal WORKS
assistance (California Work Opportunity and Responsibility to Kids), TANF
(Temporary Aide to. Needy Families), or Kin-GAP (Kinship Guardian
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Assistance Payments).
If an applicant does not have either of the above two forms of documentation, a
copy of the applicants last Federal Income Tax Return (form
1040/1040EZ/1040NR) showing that the applicants income falls under the income
eligibility guidelines listed on the application. The household size must equal the
number claimed on your income tax form.
In the rare circumstance where a Federal Income Tax Return has not been filed,
the applicant will need to submit pay stubs from the previous 30 days to the date
of application.
For residency validation, the applicant will also need to provide a copy of a valid
Driver's License or State Identification Card. If the applicant is a foster family, a
letter from the certifying Foster Agency is required. Another acceptable form of
residency is to provide the last three (3) months of utility bills.
Monthly income means the amount of income each household member receives
on a monthly basis (before taxes or other deductions are taken out) and where it
came from, such as earnings, welfare, pensions, social security, tips, strike
benefits, unemployment compensation, worker's compensation, disability
benefits, child support, alimony, cash withdrawn from savings, interest/dividerids,
rental income and any other source of income. If the amount varies from month-
to-month, please indicate the normal average monthly amount.
IV. REQUEST PROCESSING
Requests are awarded on a first-come, first-served basis and are funded only as
long as there are available resources. Assistance is issued for registration fees
only, not for supplies or other costs. Submittal of an application is not a
confirmation into the class or confirmation of fee assistance. The parent/legal
guardian must pay for the co-payment (the remaining amount of the class). A
recipient is, not assured a place in the program/class and is not considered
registered until the co-payment has been received. Co-payments must be clear
and be in cash, valid check, or VISA/MasterCard/Discover. Any past due
accounts must be brought current before a FAP application is considered.
Recipients are responsible for their own transportation to and from activity sites.
Applicants who falsify information or do not attend class regularly may be
ineligible for future fee assistance. If extenuating circumstances prevent regular
attendance, please call the office at (408) 866-2104.
Select the class/program that is appropriate for your child's age and ability as a
transfer request to a different activity will not be granted after the FAP application
has been processed. Fee assistance will not be applied retroactively. Unused
funds are not carried as credits on your account and are not transferrable.
The maximum funding allowance per child is $300.00 per calendar year with a
maximum annual benefit of $600.00 per household dependent- on availability
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of funds. The calendar year is January 1 through December 31. To the
extent permitted by State Law; family size, household income and Social Security
information will remain confidential and will not be shared for any purpose.
V. FOSTER OR INSTITUTIONALIZED CHILDREN
Use one application per foster or institutionalized child who is the legal
responsibility of the welfare agency or court Write the name of the foster or
institutionalized child and the specific school the child attends. If the foster child
or institutionalized child receives "personal use income", list the amount of the
income. "Personal Use Income" is (a) money given by the welfare office
identified by category for the child's personal use, such as clothing, school fees
and allowances, and (b) all other money the child receives, such as money from
his/her family and money from the child's full-time or part-time jobs. The foster
parent or agency official must sign the application.
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YEAR: C-O-N-F-I-D-E-N-T-I-A-L
F G�
°RCHAR9
CITY OF CAMPBELL
FINANCIAL ASSISTANCE APPLICATION
(One Form per Family- Please Print or Type)
Name Home Phone
Parent/Guardian Cell Phone
Home Address
City Zip Code
Employer Work Phone
Parent/Guardian Marital Status: ( ) single ( ) married ( ) divorced ( )widowed
Spouse's Name
Spouse's Employer Work Phone
Number of Adults in Home Number of Children in Home
Children/Dependents:
1. Relation Birth date School
2. Relation Birth date School
3. Relation Birth date School
4. Relation Birth date School
Please list your reason for assistance. Explain any special circumstances you may wish us to consider:
PROGRAM FOR WHICH YOU ARE SEEKING ASSISTANCE:
Name Class# Program Title Fee$
Name Class# Program Title Fee$
Name Class# Program Title Fee$
PLEASE COMPLETE INFORMATION ON OTHER SIDE
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Have you received Financial Assistance from the City of Campbell, Recreation & Community Services
Department before? Yes No
If yes, what program(s) did your child attend?
What year(s) did you receive assistance?
I certify that the above information is true and correct and I understand that the information
provided here will be relied upon for purpose of determining our eligibility to receive financial
assistance from the City of Campbell Recreation & Community Services Department and that any
misstatement, fraudulently or negligently, made in this or in any other statement by me may result
in the denial of my eligibility to receive financial assistance. I authorize the City of Campbell to
verify the above information. I agree to provide additional documentation to verify my need if
requested.
Signature ' Date
❑ I would like the City to keep this information private to the extent permitted by law. Please notify me
before releasing this information to anyone outside of the City.
Please provide one of the following:
1. Proof from the school district that your child is eligible for free or reduced price meals.
2. Proof that your family is receiving Food Stamps, CaIWORKS assistance (California
Work Opportunity & Responsibility to Kids), TANF (Temporary Aide to needy families),
or Kin-GAP (Kinship Guardian Assistance Payments).
3. If you do not have either of the above, a copy of your last Federal Income Tax Return
(form 1040/1040EZ/1040NR) showing that you fall under the income eligibility
Guidelines. Your household size must equal the number claimed on your income tax
form.
In addition to the above, you must provide one of the following for residency verification:
1. Copy of Driver's License or State Identification.
2. Last three months' utility bills.
Office Staff Use Only
Date scholarship approved
Percentage of scholarship
Amount of scholarship Date
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FOR OFFICE USE ONLY
HUD Income Guidelines— Updated May 2024
Median Income $184,300 for SC County 2024
_ANNUAL INCOME
100% Scholarship 50% Scholarship
Extremely Low- Very Low-Income
Income (50% of median)
Household (30% of median)
Size
1 $38,750 $64,550
2 $44,250 $73,750
3 $49,800 $82,950
— 4 $55,300 $92,150
5 $59,750 $99,550 •
6 $64,150 $106,900
7 $68,600 $114,300
8 . $73,000 $121,650 •
•
*HUD Guidelines are updated annually, the figures above represent the current amounts during
the review of this policy.
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