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2. Policies and Guidelines:

   The City of Lebanon Recreation, Arts, & Parks Department recognizes that our mission to provide quality recreation programs, special events, and parks and recreation facilities for the community’s use and enjoyment is intended for all residents and guests of the City of Lebanon. Our desire is to aid those residents and guests who do not have the financial ability to participate in our programs at full cost.

   1.    All requests for financial need are to be submitted using this Application Form.
   2.    Verification documentation is required for application approval.
   3.    Applicants who do not already receive one of the listed benefits below must obtain a letter of referral by their local Human Services agency or LISTEN Community Services.
   4.    Proof of residency is required.
   5.    Lebanon or West Lebanon residents are required to pay 25% of the resident fee and non-residents are required to pay 50% of the non-resident fee.

4. How does a person qualify for assistance:

   If participant or parent/guardian have participated in one of the following assistance programs within the last 6 months and provide documentation of at least one of these programs, approval will be granted upon fund availability.

   • Federal Public Housing Assistance/Section 8
   • SNAP Food Stamps
   • WIC Food/Nutrition Program
   • Low Income Home Energy Assistance Program (LIHEAP) - Fuel Assistance
   • Medicaid
   • National School Lunch Program (NSL)
   • Supplemental Security Income (SSI) /(SSDI)
   • Temporary Assistance to Needy Families (TANF)
   • Assistance to the Permanently and Totally Disabled (APTD)
   • Aid to the Needy and Blind (ANB)

   Applicants who do not already receive one of the above listed benefits must obtain a letter of referral by their local Human Services agency or LISTEN Community Services.  

6. Date*
7. Participant Name:*
8. Financially Responsible Individual(s)*
10. Program Requested:*
11. Phone:*
12. Email:*
14. Address:*
15. City:*
16. State:*
18. Program Fee:*
19. Amount Contributing:*
20. Amount Requested:*

    Max of 75% Resident
    Max of 50% Non-Resident

22. Please upload 1 supporting document from the "Qualify for Assistance list from above"*
Leave This Blank:


24. 1. Receive an email copy of this form.
25. Email address

    This field is not part of the form submission.

26. Submit

* indicates a required field