Recreation Assistance Program Application Form | City of Hamilton

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Recreation Assistance Program Application Form

statement

If you are having trouble filling in or submitting this form, please email [email protected] or visit your local Recreation Centre and staff will be able to assist.

Type of Application

Step 1: Eligibility

Approval is based on need using the Statistics Canada Low Income Measure numbers after tax (LIM) (currently using 2022) and is different based on the number of adults (those aged 18 or over) living at the household address on the application. Combined household income for all adults must be below the amount shown (line 23600).

For example, if there is 1 person living in the household select “1 member” below if combined income is this amount or less, if there are 2 people living in the household select “2 members” below if combined income is this amount or less, etc.

Household income and people

Combined household income & household members

1 member

2 members

3 members

4 members

5 members

6 members

7 members

8 members

9 members

10 members

11 members

12 members

13 members

14 members

15 members

Step 2: Household Information

Contact Information

Email

Phone

Address

Address 2

City/Town

Province

Postal Code

Does anyone who lives in the house, own a business?

Does anyone who lives in the house, own a business?

Yes

No

Is anyone who lives in the house self-employed?

Is anyone who lives in the house self-employed?

Yes

No

Step 3: Household Occupants

Please name all people living in the house

Status of Applicant

Applicant status:

Married

Common Law

Widowed

Divorced

Separated

Single

Occupant Name 1

Applicant

First

Last

occupant 1 barcode

Recreation Barcode (if known):

occupant 1 dob

Date of birth:

Occupant Name 2

Spouse/Partner

First

Last

occupant 2 dob

Date of birth:

occupant 2 barcode

Recreation Barcode (if known):

Additional Household Members

Include first and last name, date of birth and Recreation barcode (if known) for each household member.

Occupant Name 3

Additional household members

First

Last

occupant 3 dob

Date of birth:

occupant 3 barcode

Recreation Barcode (if known):

Occupant Name 4

Additional household members

First

Last

occupant 4 dob

Date of birth:

occupant 4 barcode

Recreation Barcode (if known):

Add additional household member(s)

Add additional household member(s)

Occupant Name 5

Additional household members

First

Last

occupant 5 dob

Date of birth:

occupant 5 barcode

Recreation Barcode (if known):

Occupant Name 6

Additional household members

First

Last

occupant 6 dob

Date of birth:

occupant 6 barcode

Recreation Barcode (if known):

Occupant Name 7

Additional household members

First

Last

occupant 7 dob

Date of birth:

occupant 7 barcode

Recreation Barcode (if known):

Occupant Name 8

Additional household members

First

Last

occ_8

occupant 8 dob

Date of birth:

occupant 8 barcode

Recreation Barcode (if known):

Add additional household member(s)

Add additional household member(s)

Occupant Name 9

Additional household members

First

Last

occupant 9 dob

Date of birth:

occupant 9 barcode

Recreation Barcode (if known):

Occupant Name 10

Additional household members

First

Last

occupant 10 dob

Date of birth:

occupant 10 barcode

Recreation Barcode (if known):

Occupant Name 11

Additional household members

First

Last

occupant 11 dob

Date of birth:

occupant 11 barcode

Recreation Barcode (if known):

Occupant Name 12

Additional household members

First

Last

occupant 12 dob

Date of birth:

occupant 12 barcode

Recreation Barcode (if known):

Occupant Name 13

Additional household members

First

Last

occupant 13 dob

Date of birth:

occupant 13 barcode

Recreation Barcode (if known):

Occupant Name 14

Additional household members

First

Last

occupant 14 dob

Date of birth:

occupant 14 barcode

Recreation Barcode (if known):

Occupant Name 15

Additional household members

First

Last

occupant 15 dob

Date of birth:

occupant 15 barcode

Recreation Barcode (if known):

Step 4 – Benefit Requesting

(benefits are for 12 months)

For Families

for families - select

Select all that apply

For Adults/Seniors (no children at address)

for adults/seniors-select

Select one

Step 5: Proof of residency in the City of Hamilton

Upload ONE of the following which lists your current address:

Proof of residency items

Upload proof of residency

File size is limited to 100 MB. Contact [email protected] if you have a large file and are experiencing diffilcuty uploading.
One file only.
100 MB limit.
Allowed types: gif, jpg, jpeg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, mp4, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip.

Step 6: Proof of income

You must provide a copy of 1 or more of the following to prove your household income.

Proof of income items list

Most Current Government issued Notice of Assessment showing line 23600 for all adults in the house
Child Tax Benefit Statement with the family net income
GST/ HSTC Notice with the family net income

If you do not have these papers, contact Canada Revenue Agency 1-800-959-8281

Permanent Residency Papers dated within the last year for everyone
Ontario Works/ Disability Eligibility Card – with the names of everyone in the house or a printout from your online “My Benefits” account
Any full-time student supported by a parent/guardian can provide proof of full-time school enrollment

Upload proof of income file(s)

File size is limited to 100 MB. Contact [email protected] if you have a large file and are experiencing diffilcuty uploading.
Maximum 5 files.
100 MB limit.
Allowed types: gif, jpg, jpeg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, mp4, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip.

Outro

RAP benefits are for 12 months. Please space out your funds accordingly as you will not be given additional funds before your expiry date.
Incomplete applications will not be processed.
Please contact the office for updates. If you are unable to provide any of the requested information, but feel you would be eligible for this program, please contact the office to discuss.

Step 7: Terms and Conditions

I give the City of Hamilton permission to verify the information provided in this application with all necessary sources for the purpose of assessing my application.
I certify that the information I have provided on this application is truthful, complete and to the best of my knowledge. Misuse of program privileges or misinformation provided on this application form may result in loss of privileges or penalty. Additional information may be required to verify eligibility.
I understand that the collection, use, disclosure and destruction of all information submitted on this form is governed by Ontario’s Municipal Freedom of Information and Protection of Privacy Act.
If I or anyone in my household has a change in circumstances (e.g. change of address, new job etc.) that changes the information provided in this application, I will immediately notify the City’s Recreation Department at the number below. I understand that changes may result in a reduction or loss of privileges.

Applicant Signature

Sign above

Notice of Collection

The City of Hamilton collects information under authority of Section 227 of the Municipal Act, 2001. Any personal information collected for the Recreation Assistance Program will be used for/to determine program eligibility. By providing your email address, you are consenting to receiving emails from the City of Hamilton and/or their agents/contractors for purposes related to notifying individuals of their program eligibility. Information collected for this initiative may be stored on servers located in Canada and the United States and may be subject to Canadian and/or American laws. Questions about the collection of this personal information can be directed to the Manager, Citywide Programs and Standards, 28 James Street N, 3^rd Floor, Hamilton L8R 1A1, 905-546-2424 ext. 4569, and [email protected].

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