Apply for a Financial Hardship Fee Reduction The Department of Parks and Recreation (DPR) charges fees for programs and services as approved by the Arlington County Board each year. However, fees are not intended to be a deterrent for the community wishing to participate in programs. In addition to the Fee Reduction Policy that DPR offers for households based on income qualifications, a separate financial hardship process is available whereby households may apply for temporary financial hardship exemption for certain offerings if that household has a documented temporary financial hardship. If you have an ongoing need based on income qualifications , complete the Annual Fee Reduction Request Process. If your household is currently experiencing a temporary financial hardship and is unable to pay the full cost for DPR programs, use the form below and provide the information requested. Financial hardship approvals will be determined based on documented inability to pay the published fee for DPR program offerings. Summer Camp Payment Plans & Hardship FAQ’s | Questions? Email: email@example.com. Date of Request* Date Format: MM slash DD slash YYYY Primary Guardian* First Last DPR Household ID(if you have one)Part 1: RequestPlease check appropriate statement(s). My household has been granted a current annual fee reduction. My household is currently experiencing a temporary economic issue and we are unable to pay the full cost for DPR programs. I am requesting that the household fee(s) be adjusted on a temporary basis for specific Arlington Parks and Recreation offerings. Statement of Reason* Upload Supporting DocumentsExamples of supporting documentation include an email/document from the employer confirming that the salary has been reduced or they have lost employment. Drop files here or Part II: IncomeBased on Current Financial Assessment Total Monthly Income Lost in Current Situation*Total Regular Monthly Income*Total change in monthly expenses (if applicable)Current Fee Reduction Level (if applicable)Part III: Program OfferingsPlease detail the requested household enrollments for Arlington Parks and Recreation activities.Program NameActivity CodeWeek# of ParticipantsFee SignatureVirginia Freedom of Information Act NoticePlease be aware that information submitted through an Arlington County Government website is considered to be a Public Record under the Virginia Public Records Act and may be subject to release by the County in response to a request made under the Virginia Freedom of Information Act. Do not submit any unsolicited personally identifiable information including (but not limited to) your: (1) social security number; (2) driver's license number; (3) bank account numbers; (4) credit or debit card numbers; (5) personal identification numbers (PIN); (6) electronic identification codes; (7) automated or electronic signatures; or (8) passwords; or (9) any other numbers or information that can be used to access your assets, obtain identification, act as identification, or obtain goods or services.Arlington County may withhold your name, contact information, and program participation in accordance with the Virginia Freedom of Information Act. Please indicate, by checking the box below, if you would like for the County to seek to keep this information confidential. Please do not disclose my name, contact information, or program participation in response to a request under the Virginia Freedom of Information Act. I recognize that the County cannot guarantee the confidentiality of my name, contact information, or program participation but ask that it do so to the extent permitted by law. I hereby attest that all the information I have listed is true and correct to the best of my knowledge. Head of Household Signature*CommentsThis field is for validation purposes and should be left unchanged.