Application: Program Support Subsidy

Sturgeon Region Residents
Child Registration Subsidy (Sponsor A Child)

Sturgeon County Residents Only
Sturgeon County Adult Registration Subsidy Aging in Place Subsidy

Sturgeon County Family and Community Support Services (FCSS)will support children and adults who may be experiencing financial hardship and cannot otherwise participate in programs. For programs not offered in these communities, programs offered in neighboring communities will be considered.

Sponsor a Child Program Registration Subsidy: Will provide sponsorship to qualifying families for children living in any community within the Sturgeon Region for programs throughout the year.

Sturgeon County Adult Program Registration Subsidy: Will provide sponsorship for qualifying adults who are rate payers of Sturgeon County for recreation programs throughout the year.

Sturgeon County Aging in Place Subsidy: Qualifying seniors or medically at risk adults who live in their own home, who are rate payers of Sturgeon County can access partial to full subsidy for support to allow them to remain in their home. Supports could include housekeeping, transportation, frozen meals, etc. Applicants will need to undertake an initial assessment with our Living Well program staff.

To qualify for this program, the combined taxable family income should be less than listed below or you should have extraordinary living expenses that would impact ability to pay:

Program Guidelines

Program Registration Fee Subsidy – Adult Registration and Child Registration through Sponsor a Child

• Program subsidy may be provided for a maximum of $175.00 per person per calendar year. Applicants will be encouraged to pay an affordable portion of the program fee.
• Sponsor a Child applicants will be supported in applying for other additional subsidy programs such as Jump Start.
• Applicant must complete the Financial Subsidy Request Application form. (attached)
• If applicant does not attend the registered course or program, future applications for assistance may be affected.

Aging in Place Support

• Applicants can qualify for full to partial subsidy dependent on income with maximum subsidy per household per year of $1,200.
• Successful applicants will have an intake assessment take place at their home by our Living Well staff.
• Applicants will be supported in applying for other benefits including the Seniors’ Benefit program and the Special Needs Assistance Grant.
• Successful applicant will be required to enter into a service agreement with Sturgeon County Family & Community Support Services.
• Subsidies will be provided directly to the Service Provider. The applicant is responsible for payment of the non-subsidizes fees and failure to pay will result in subsidy being revoked.

Please allow two weeks for applications to be processed.
The decision of the Family & Community Support Services Department is final.

ALL APPLICATIONS WILL BE HELD IN STRICTEST CONFIDENCE

Apply Online

Having Trouble Completing the Form Online?

Sturgeon County Family & Community Support Services
Mail in 9613 – 100 Street, Morinville, Alberta T8R 1L9
Walk in at 9608 – 100 Street, Morinville
Phone: 780-722-1479 Fax: 780-939-2893
Email: livingwell@sturgeoncounty.ca

Applicant Information

Applicant Name:(Required)

First Last

Mailing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country

Municipality(Required)

Home/Cell No.(Required)

Work No.

Family Information

Number of Adults (18 years +) in the Household(Required)

Number of Children (under 18 years) in the Household(Required)

Are you presently receiving government assistance (i.e. SFI, AISH, CPP, Seniors Benefit)?(Required)

Yes

No

Are you working with a worker with another government service?(Required)

Yes

No

If yes, have you discussed the possibility of supports with that service?(Required)

Yes

No

Please state approximate net family earnings per month. Include income from:(Required)

Part time job, Full time job, Alberta Works, Canada Pension/RIFs, Alimony/Child Support, EI, Seniors’ Benefit, Other

Net Monthly Income(Required)

*Monthly income after deductions

Sturgeon County reserves the right to request certification of earning. Applicants can qualify due to extraordinary living expenses. If this is the case, please attach a monthly household budget. Our program staff can provide support with qualifying due to high living expenses. The personal information provided will be used to process your request for subsidy for yourself or your child and is collected under the authority of Section 33(c) of the Freedom of Information and Protection of Privacy Act. If you have any questions about the collection and use of this information, please contact the Sturgeon County Access and Privacy Coordinator at 9613 – 100 Street, Morinville, Alberta, T8R 1L9 (780) 939.4321 or foip@sturgeoncounty.ca.

Program Fee Registration Subsidy

Please list the program(s) you wish to have subsidized or attach a copy of your registration form.

Program Name

Program Contact Name

First Last

Program Contact Phone

Participant Name(s)

Cost of Program

Program Name

Program Contact Name

First Last

Program Contact Phone

Participant Name(s)

Cost of Program

Program Name

Program Contact Name

First Last

Program Contact Phone

Participant Name(s)

Cost of Program

Aging in Place Subsidy

Please type of support and frequency you require.

Support Needed

Frequency Required

Support Needed

Frequency Required

I hereby certify that the information provided in this application is valid. If approved for subsidy, I give Sturgeon County FCSS staff permission to contact organization(s) providing the program(s) to share information required to make arrangements for payment in relation to the subsidy granted. I give Sturgeon County FCSS staff permission to contact other support or subsidy programs to assist with connection to other subsidy opportunities.

Signature

Date

MM slash DD slash YYYY

Office Use

Earning documentation provided (initial to verify)

Total Subsidy Recommended

Notes