Financial Assistance Form
As a non-profit organization, Midcoast Recreation Center aims to offer all community members access to our programs, regardless of their ability to pay. Our Financial Assistance application process helps us understand the needs of our community and allocate our funds to those who need it most.

Please fill out this form and then email Page 1 of your most recent Tax return to financialassistance@midcoastrec.org.  
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Applicant Name *
Date of Birth *
Mailing Address *
Phone number *
Email *
Phone Number *
Programs of Interest *
Required
Family Members
Please provide the names of ALL family members living in your household; Financial Assistance is partially determined by this number. If approved, all family household members are entitled to Financial Assistance. Please list First and Last names as well as Date of birth and relationship to the applicant. 
Family Members *
Household Income
Please indicate total yearly household income to include monthly earnings from employment, unemployment, ASPIRE, TANF, child support, alimony, Social Security, pensions, retirements, and all other income. 
Household Income *
Required
What benefits do you feel you and/or your family will gain from our programs and services? *
Are there any extenuating circumstances you would like us to consider? *
Disclaimer
I am requesting financial assistance from MRC due to my personal circumstances and certify that all information submitted is correct, complete, and accurate. I understand that all information submitted will be kept confidential. 
Applicant or Guardian Signature ( If under 18)  *
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