HomeMy WebLinkAboutAgenda_2017_1_9_Meeting(290)RAMBLING RIVER CENTER ADVISORY BOARD MEETING
9:30 AM, January 9, 2017
Rambling River Center Nicolai Board Room
AGENDA
1.Call to Order
2.Approve Agenda
3.Approve Minutes
a.Ap p ro ve Dec emb er 12, 2016 Meeting Minutes
4.Presentations
a.R ecognitio n o f S ervic e for S arah Miller
5 Business Items
a.C o mmunity Expo Participation
b.Ap p ro ve 2017 Annual Work Plan
c .2017 Arts and Crafts Sale
d.R amb ling River Center Cap ital Imp ro vement Priority
e.F inancial Sup p o rt Program Form and Report
6.Discussion Items
a.2017 Farmingto n VFW Steak Fry F und rais er
7.Staff Report
a.S taff Updates
8.Advisory Board Roundtable
a.Ad vis ory Board Roundtable Format
9.Items for Next Meeting Agenda
a.Items for February 13, 2017 Meeting Agend a
10.Adjourn
City of Farm ington
430 Third S treet
F armington, Minnes o ta
651.280.6800 - F ax 651.280.6899
www.ci.farmingto n.mn.us
TO:Ramb ling River Center Advis o ry Bo ard
FROM:Randy Dis tad, Parks and R ecreatio n Direc tor
SUBJECT:Ap p ro ve Dec emb er 12, 2016 Meeting Minutes
DATE:January 9, 2017
INTRODUCTION
Attac hed fo r review are the draft minutes fro m the Dec emb er 12, 2016 Ramb ling R iver Center Ad visory
Bo ard (Ad vis o ry Bo ard ) meeting.
DISCUSSION
Advis o ry Board memb ers sho uld review the minutes for any c o rrectio ns or ed its that s hould be mad e prio r
to ap p ro val by the Ad visory Board.
ACTION REQUESTED
The Ad visory Bo ard is b eing asked to appro ve the attac hed minutes fro m the December 12, 2016 meeting.
ATTACHMENTS:
Type Description
Exhibit December 12, 2016 Meeting Minutes
City of Farmington A Proud Past - A Promising Future
325 Oak Street Committed to Providing High Quality,
Farmington, MN 55024 Timely and Responsive Service to All
Of Our Customers
DRAFT
DECEMBER 12, 2016 RAMBLING RIVER CENTER
ADVISORY BOARD MEETING MINUTES
1. Call to Order: Meeting was called to order by Chair Schmidtke at 9:30am. Quorum was present.
Members Present: Marilyn Briesacher, Roger Wood, Kay Bennett, Fred Schmidtke, Sarah Miller,
and Blanche Reichert
Members Absent: Marjorie Koski
Others Present: Parks & Recreation Director Randy Distad and Recreation Supervisor Missie
Kohlbeck
2. Approve Agenda
Motion made by Breisacher to approve December 12, 2016 meeting agenda and seconded by Bennett.
APIF. Motion carried.
3. Approve Minutes
Motion made by Bennett to approve November14, 2016 meeting minutes and seconded by Reichert.
APIF. Motion carried.
4. Presentations
A. Director Distad wins Clifton E. French Award
Recreation Supervisor Kohlbeck explained to the Advisory Board that Director Distad has won the
highest award the MN Recreation and Parks Association gives. It is given to someone with 20 or more
years of experience in the field whom has provided outstanding service. Distad will receive the award
at a banquet on January 10, 2017.
B.Attendance Records
Director Distad reviewed the attached attendance record. He shared board members are paid $20 per
meeting attended. Motion made by Bennett to accept the attendance record seconded by Reichert. APIF.
Motion carried.
Miller and Reichert’s terms on Board are expired. Reichert is reapplying and Miller is planning to
move on to other interests. The Board and staff thanked Miller for her service.
5. Business Items
A. April 22, 2017 Arts and Craft Sale
Bennet has sent out a letter to potential crafters. Reservations are coming in. Recreation Supervisor
Kohlbeck will see if Trinity will share their list of crafter. Staff and Board Members will continue to
work on sale.
B. Final Review 2016 Annual Work Plan Items
Motion by Briesacher to accept the final completed 2016 Annual Work Plan items and seconded by
Bennett. APIF motion carried.
C. Draft 2017 Annual Work Plan Review
Director Distad asked members to review and bring any items forward they would like to discuss. He
informed Board members that they should be ready to approve the 2017 work plan at the next meeting.
6. Discussion Items
A. AARP Income Tax Preparations
Recreation Supervisor Kohlbeck has researched the possibility of AARP taxes returning to the RRC.
AARP is looking to do incomes taxes at the Dakota County Library in Farmington if they can find
enough volunteer staff. The general consensus was that if ARRP ever wanted to come back to the RRC
to do income taxes and have enough volunteer, then they would be welcome to come back to the RRC.
B. Fundraising Ideas
Board members were asked to provide any ideas they may have about additional fundraising
opportunities. Bennett suggested a talent show. Work will continue on the Arts and Craft Sale with the
goal of expanding. 2017 is the year for the garage sale. When it is time for silent auction/waffle
breakfast review, it was determined to discuss more closely the bake sale because of a concern with
marking down bake sale items and people waiting until the mark down occurs before they purchase.
7. Staff Report
Recreation Supervisor Kohlbeck stated she is currently working on getting 2017 membership renewal
forms out. Steak Fry sign-up sheet for volunteers will be posted by end of the week.
8. Commission Roundtable
Miller: Stated she has enjoyed the time she has served on the Board. She is proud she was on the Board
when the old city hall was turned into the new Rambling River Center.
Bennett: Thanked Miller, looking forward to Arts and Crafts Sale, would like us to check into Knights
of Columbus lasagna dinner similar to Heritage Center Lakeville.
Briesacher: Thanked Miller!
Wood: Thanked Miller!
Reichert: Thanked Miller!
Schmidtke: Thanked Miller! Reminded the Board to remember to volunteer to help at the Steak Fry.
9. Agenda Items for January 9, 2017 Meeting
A. 2017 Annual Work Plan
B. Steak Fry
C. Community Expo
D. Arts and Crafts Sale
10. Adjourn
Miller motioned and Wood seconded to adjourn the meeting. APIF. Meeting adjourned at 10:35 a.m.
Respectfully Submitted
Missie Kohlbeck
Recording Secretary and Recreation Supervisor
City of Farm ington
430 Third S treet
F armington, Minnes o ta
651.280.6800 - F ax 651.280.6899
www.ci.farmingto n.mn.us
TO:Ramb ling River Center Advis o ry Bo ard
FROM:Randy Dis tad, Parks and R ecreatio n Direc tor
SUBJECT:Recognitio n o f Servic e fo r S arah Miller
DATE:January 9, 2017
INTRODUCTION
The Ad visory Bo ard s et guidelines up o n whic h memb ers go ing off the Board are recognized fo r their
s ervic e. Sarah Miller has met the guid elines to be recognized fo r her service while o n the Advis o ry Bo ard.
DISCUSSION
Sarah Miller info rmed Advis o ry Bo ard memb ers that s he will no t b e sub mitting an ap p licatio n fo r
reap p o intment to the Advis o ry Bo ard . It's imp o rtant to note S arah has s erved on the Ad visory Board s inc e
June 2000. With mo re than 16 years o f servic e, Sarah deserves to be recognized for the outstanding
s ervic e she has p ro vided to the Ramb ling River C enter while o n the Advis ory Board.
ACTION REQUESTED
The Ad visory Bo ard is b eing asked to formally recognize and thank Sarah Miller fo r the mo re than 16 years of
s ervic e she has p ro vided o n the Ramb ling River C enter Advis o ry Bo ard .
City of Farm ington
430 Third S treet
F armington, Minnes o ta
651.280.6800 - F ax 651.280.6899
www.ci.farmingto n.mn.us
TO:Ramb ling River Center Advis o ry Bo ard
FROM:Randy Dis tad, Parks and R ecreatio n Direc tor
SUBJECT:Co mmunity Expo Partic ip ation
DATE:January 9, 2017
INTRODUCTION
The Community Expo will b e held at the Farmington High S cho o l from 9:00 a.m. to 12:00 No o n o n
Saturday, January 28, 2017.
DISCUSSION
The Rambling R iver Center has p ro vided info rmation at a b o o th during the C o mmunity Expo. In years pas t,
Advis o ry Board memb ers have volunteered to work a s hift and assist the R ec reatio n Sup ervisor with
p ro viding info rmation to the p ublic at the b ooth. Staff is req uesting the Advis o ry Bo ard determine who will
as s is t Rec reatio n Sup ervisor Mis s ie Ko hlbec k during the Community Expo.
ACTION REQUESTED
By mo tion ap p ro ve the vo lunteers who will as s is t Rec reation S upervis o r Mis s ie Ko hlbec k d uring the
Community Expo o n January 28, 2017.
City of Farm ington
430 Third S treet
F armington, Minnes o ta
651.280.6800 - F ax 651.280.6899
www.ci.farmingto n.mn.us
TO:Ramb ling River Center Advis o ry Bo ard
FROM:Randy Dis tad, Parks and R ecreatio n Direc tor
SUBJECT:Ap p ro ve 2017 Annual Wo rk Plan
DATE:January 9, 2017
INTRODUCTION
At the b eginning of each year the Ad visory Bo ard approves an annual wo rk plan for the c o ming year. The
annual work p lan o utlines the types o f wo rk items the Ad visory Board wishes to acc o mp lis h in the c o ming
year.
DISCUSSION
Attac hed is a draft 2017 Annual Wo rk Plan that the Advis o ry Bo ard is b eing as ked to review. The annual
work plan is a p ro d uc t o f the d is cus s io n that oc c urred at the Dec emb er 12, 2016 Advis o ry Bo ard meeting.
ACTION REQUESTED
The Ad visory Bo ard is b eing asked to review prior to the meeting the attached d raft work plan and then
d is cus s and ap p ro ve it d uring the meeting.
ATTACHMENTS:
Type Description
Exhibit 2017 Draf t Work Plan
DRAFT 2017 WORK PLAN
RAMBLING RIVER CENTER ADVISORY BOARD
Goal #1: To promote and increase Rambling River Center memberships.
Objectives
1. By February 1st, assist the Recreation Supervisor at the Community Expo to promote the Rambling
River Center membership.
2. By October 1st, assist the Recreation Supervisor at the Farmer’s Market to promote the Rambling
River Center.
3. By December 1st, at least one Advisory Board member will have assisted the Recreation
Supervisor with visits to Senior Housing buildings and care facilities to promote the Rambling
River Center.
Status: Not completed.
Goal #2: Review and update, if needed, the Financial Support Program (FSP) guidelines and
information.
1. By March 1st review and approve a recommendation on the FSP application form.
2. By May 1st, review and approve any updates to the FSP funding amounts to individuals.
3. By August 1st review and approve any updates to the FSP informational literature and brochures.
Goal #3: Identify and approve a list of capital improvement project items to be completed at the
Rambling River Center and then begin completing the improvement projects.
Objectives
1. By March 1st, review and revise, if needed, the current long term capital improvement items and
the estimated costs of the improvements.
2. By April 1st, determine at least one capital improvement to make or capital equipment to purchase
for the Rambling River Center.
3. By December 31st, complete at least one capital improvement item or purchase one capital
equipment item on the identified capital improvement project list for the Rambling River Center.
Goal #4: Continue fundraising efforts to fund Rambling River Center’s future capital
improvement projects by raising at least $10,000 through at least three fundraising events and from
donations.
Objectives:
1. By April 1st, assist with at least one fundraising activity.
2. By July 1st, assist with at least a second fundraising activity.
3. By October 1st, assist with at least a third fundraising activity.
4. By December 31st, assist with at least a fourth fundraising activity..
Goal #5: Work with staff to create and implement either three new programs or make revisions to
three existing programs.
Objectives:
1. By February 1st, at least one new program idea will have been discussed with staff and then
implemented.
2. By August 1st, at least a second program idea will have been discussed with staff and then
implemented.
3. By December 1st, at least a third program idea will have been discussed with staff and then
implemented.
Goal #6: Participate in the city’s Comprehensive Plan update to address future needs of the city’s
population of older adults.
Objectives
1. By July 1st there will have been a discussion on what items should be included in the
comprehensive plan update that relates to the needs of the city’s population of older adults
including but not limited to transportation, recreational programs, facilities, and resources
available.
2. By October 31st there will have been a second discussion on what items to include in the city’s
comprehensive plan that relates to the needs of the city’s population of older adults.
3. By December 31st there will have been a recommendation made by the Advisory Board that
outlines what language should be included in the city’s comprehensive plan that meets the needs of
the city’s population of older adults.
Goal #7: Work with staff to offer a second Aging Mastery Program (AMP).
Objectives
1. By March 1st, the Advisory Board will have had an opportunity to discuss and determine when to
offer a second AMP class.
2. By September 1st, a second AMP class will be offered.
3. By October 31st, there will be a review and evaluation of the second AMP class offered.
Goal #8: Work with staff to determine if AARP income tax preparation should occur at the RRC in
2018.
Objectives
1. By April 1st, the Recreation Supervisor will have been in contact with AARP about having the
income tax preparations returning to the Rambling River Center.
2. By July 1st, the Advisory Board will have discussed the return of the AARP income tax returns
provided that AARP is interested in returning this service to the Rambling River Center and can
make a commitment to find volunteers to staff it.
3. By October 1st, the Advisory Board will make a decision about allowing AARP income tax returns
to occur at the Rambling River Center provided that AARP is interested in returning the service to
the Rambling River Center and can make a commitment to find volunteers to staff it.
City of Farm ington
430 Third S treet
F armington, Minnes o ta
651.280.6800 - F ax 651.280.6899
www.ci.farmingto n.mn.us
TO:Ramb ling River Center Advis o ry Bo ard
FROM:Randy Dis tad, Parks and R ecreatio n Direc tor
SUBJECT:2017 Arts and Crafts Sale
DATE:January 9, 2017
INTRODUCTION
The Rambling R iver Center will b e ho ld ing its s ec ond annual Arts and Crafts S ale on April 22, 2017 as a
fund rais ing event.
DISCUSSION
An up d ate will be p ro vided b y s taff ab o ut the s tatus of the Arts and Crafts S ale. Advis o ry Bo ard members
are being as ked to participate in a d is cus s ion and make further dec is io ns related to this fund rais ing event
b eing held at the R amb ling River Center.
ACTION REQUESTED
The Ad visory Bo ard is b eing asked to c o me and further d is cus s the Arts and C rafts Sale fund rais ing event and
b e prepared to make further dec is io ns needed before it is held .
City of Farm ington
430 Third Street
Farmingto n, Minnesota
651.280.6800 - Fax 651.280.6899
www.c i.farmingto n.mn.us
TO:Ramb ling River Center Advis o ry Bo ard
FROM:Randy Dis tad, Parks and R ecreatio n Direc tor
SUBJECT:Ramb ling River Center C ap ital Imp ro vement Priority
DATE:January 9, 2017
INTRODUCTION
The Ad visory Bo ard in the p as t has reviewed, prioritized and then selec ted R amb ling River Center
imp ro vement projec ts to complete or eq uipment to purchas e.
DISCUSSION
Attac hed is a lis t of imp ro vement p ro jects c ompleted and equip ment items p urc has ed s inc e fundraising
events have o c c urred. T he lis t attached also inc lud es improvement projec ts yet to b e c o mp leted and
eq uipment yet to b e purchas ed . The attac hed doc ument was created by the Advis o ry Bo ard members in the
p as t. Ad visory Bo ard members s hould review the lis t o f projec ts not c o mpleted and equip ment no t
p uc hased and determine if there are any o ther items to ad d . Then after reviewing the list, each Advis o ry
Bo ard member s ho uld come p rep ared at the meeting to disc uss the item or items they feel have the highes t
p rio rity. Bas ed o n the disc ussion that oc curs there will be a list of p ro jects and/o r equip ment that have the
highest priority for completing.
Attac hed is the up d ated b alanc e in the fundrais ing fund . This sho ws what the fund balance is as o f January
3, 2017.
ACTION REQUESTED
Advis o ry Board memb ers are as ked to make a d ecis ion on what projec t(s) s ho uld b e c o mp leted and/o r what
eq uipment s ho uld b e purchas ed in 2017 b as ed o n fund s being available to do s o .
ATTACHMENTS:
Type Description
Exhibit Future Building Improvements and Equipment
Purchases List
Exhibit RRC CI P Fund Balance
As of January 3, 2017
4502 Rambling River Center Capital Improvement Fund Expenditures
List of Completed Building Improvements and Equipment Purchases
Building Improvement/Equipment Item Cost Year
Completed
Banquet Room acoustic improvements $5,459.00 2013
Arts and Crafts Room concrete floor resurfacing Improvement $4,200.00 2013
Purchase and install security video cameras in Fitness Room, Banquet Room, Oak Street
entrance hallway and hallway leading from/to Banquet Room
$4,256.00 2013
PC and monitor for security cameras $1,074.00 2013
Purchase new banquet tables donated by Coffee Guys $1,353.00 2013
Replace arm chairs in Jerry Ristow Library and Empire Room sitting area $1,498.00 2014
Purchase greeting card rack by Kay Bennett $200.00 2014
Construction of concrete garage apron along Oak Street by Farmington Liquors $6,266.00 2014
Carpet and chair cleaning equipment and Portable PA System by Coffee Guys 275.00 2015
Purchase new treadmill for McKnight Fitness Center $3,665.00 2014
Library bookshelves donated by Kay Bennett and Marilyn Briesacher $3,200.00 2014
Concrete Flower Containers Oak Street entrance area donated in memory of Jim Steege $751.00 2015
Benches for Oak Street entrance area donated by Louis Schmitz Foundation $1,418.00 2015
Bookshelf for Jerry Ristow Library donated by Betty Steege $325.00 2015
Front entrance separation wall and counter top $900.00 2015
Table and lamps Charles Finstad $789.00 2015
Enclosing Front Reception Area with Locking Roll Up Security Gate $2,713.00 2015
Front desk area cabinets donated by the Rotary Club of Farmington $4,512.00 2016
34 chairs for Nicolai Board Room and Harry and Louise Ross Room donated by the
Farmington Lions Club and Rotary Club of Farmington
$4,080.00 2016
150 Chairs for Banquet Room and Empire Room $19,500 2016
50 Chairs donated by Empire Township $6,500 2016
Security Camera Oak Street Entrance $585.00 2016
Laptop donated by Matt Little $555.00 2016
TOTAL $74,074.00
As of January 3, 2017
List of Future Possible Building Improvements and Equipment Purchases
Building Improvement/Equipment Item Estimated Cost Year to be Completed
Additional Lighting Fixtures in Banquet Room $2,400 2017
Expand Fitness Room No year identified yet
Purchase NU Step $4,500 No year identified yet
Purchase additional recumbent bike $5,000 No year identified yet
Tile hallway walls four feet up $2,500 No year identified yet
Purchase and Install Sink in Craft Room $3,000 No year identified yet
HVAC System Replacement $10,000 2025
One Waste Container for Oak Street Entrance Area $700 2017
Security Cameras (4th Street parking lot) $1,000 No year identified yet
Kitchen faucet replacement (gooseneck) $200 No year identified yet
Six foot tables (10 @ $100 each) $1,000 No year identified yet
Eight foot tables (8 @ $150 each) $1,200 No year identified yet
Blinds for various rooms especially Banquet Room $1,500 No year identified yet
Pergola for seating area by Oak Street entrance $1,000 No year identified yet
Three sided kiosk information center $3,000 No year identified yet
Banquet Room flooring $12,000 No year identified yet
Harry and Louise Ross Room flooring $3,000 No year identified yet
Puzzle Table $100 No year identified yet
Cart for Harry and Louis Room $250 No year identified yet
Built in cabinets for Harry and Louis Ross Room $6,000 No year identified yet
Rambling River Center Capital
Improvement Project Fund Balance
Account Account Account Account DescriptionDescriptionDescriptionDescription 2012201220122012 2013201320132013 2014201420142014 2015201520152015 2016201620162016
OPERATING TRANSFERS 10,000.00 0.00 0.00 0.00
DONATIONS 13,093.63 16,325.09 13,901.27 20,441.66 21,965.00
OFFICE SUPPLIES 109.00
EQUIP SUPPLIES & PARTS -4,905.20 -8,224.54 -6,573.95 -1,175.00
BUILDING SUPPLIES & PARTS -3,430.00 0.00 -891.74 0.00
PROFESSIONAL SERVICES -6,159.00 -1,050.00 -7,979.00 -2,424.00
ADVERTISING -182.95 0.00 0.00 0.00
PROGRAMMING EXPENSE -1,480.38 -4,157.68 -276.04 -380.66 -524.00
FURNITURE & OFFICE EQUIPMENT -788.50 -26,000.00
OTHER CONSTRUCTION COSTS -6,265.92 0.00 -2,713.00
11,613.2511,613.2511,613.2511,613.25 7,490.267,490.267,490.267,490.26 -1,915.23-1,915.23-1,915.23-1,915.23 3,827.813,827.813,827.813,827.81 -10,762.00-10,762.00-10,762.00-10,762.00
Current
Available
Balance
$10,254.09
As of January 3, 2017
City of Farm ington
430 Third S treet
F armington, Minnes o ta
651.280.6800 - F ax 651.280.6899
www.ci.farmingto n.mn.us
TO:Ramb ling River Center Advis o ry Bo ard
FROM:Randy Dis tad, Parks and R ecreatio n Direc tor
SUBJECT:F inancial Sup p o rt Program Form and Report
DATE:January 9, 2017
INTRODUCTION
The Rambling R iver Center currently o ffers a F inancial Sup p o rt Program (FS P) that is funded thro ugh a
Community Development Blo ck Grant that c o mes through the Dako ta County C o mmunity Development
Agenc y fro m the Unites S tates Dep artment of Hous ing and Urb an Develo pment (HUD).
DISCUSSION
Inc luded in the p ac ket is an up d ated FSP app lic atio n fo rm. S taff would like to review the revised fo rm with
the Advis o ry Board, s o the revis io ns can be exp lained.
Additio nally, fo r the next fis cal year o f CDBG funding, whic h runs July 1, 2017 to June 30, 2018, the FSP
p ro gram will be red uc ed from $5,000 to $2,500 due to a cut in CDBG fund ing from HUD.
ACTION REQUESTED
The Ad visory Bo ard is b eing asked to review the attached revis ed FSP fo rm and come p rep ared to disc us s
and as k q uestions about the form d uring the meeting.
ATTACHMENTS:
Type Description
Exhibit 2017 FSP Application
Rambling
River
Center
Farmington Seniors
The Rambling River Center is
committed to providing
quality programs and services,
while encouraging the
involvement of adults over age
50.
325 Oak Street
Farmington, MN 55024
P: 651.280.6970
F: 651 -280-6979
www.ci.farmington.mn.us
Financial Support Program (FSP)
Information & Application Packet
Thank you for your interest in programs, trips and memberships at the
Rambling River Center. Information and application for the FSP is available
in this packet.
Please return completed application, supporting materials and
registration form to:
Missie Kohlbeck, Recreation Supervisor
Rambling River Center
325 Oak Street
Farmington, MN 55024
Rambling River Center’s Financial Support Program
1. Financial aid is given to all adults’ ages 62 years and over and to adults between the ages of 50 and
61 years who meet the low to moderate income level.
2. FSP can be used for either an annual membership, lessons, programs and/or activities offered by
Rambling River Center. Some restrictions may apply so check with Rambling River Center staff
first to make sure the financial aid money qualifies for the service you want to purchase.
3. Maximum amount given per calendar year will be $50 per household member.
4. Applicants must be residents living within the boundaries of ISD #192.
5. Applications must be completed and received in the Recreation Supervisor’s office at Rambling
River Center located at 325 Oak Street, Farmington, MN.
6. All application and financial information provided are considered private data on individuals and
is subject to privacy of information provisions, pursuant to State Statute.
7. City staff reserves the right to verify all information contained on the application form in order to
grant, deny or revoke any FSP monies.
8. Applicants will only be notified if the FSP request has been denied. Notification will occur in a
timely manner by email or phone.
9. A completed program registration and any partial payment must accompany the FSP application
form.
10. Failure to attend an activity or program that has been paid through the FSP program may jeopar-
dize future FSP funding but will be determined on a case by case basis.
11. Persons applying for FSP funding must meet certain income limits to qualify for FSP funding.
Applicant must acknowledge by signing the application form that they meet the low to moderate
income guidelines if using this method of determining eligibility for financial aid.
12. We understand that from time to time households may encounter some unforeseen and unfortu-
nate financial circumstances. During these times this program may provide some financial aid to
help the household meet some of their social and recreational needs. If you feel you are in need of
financial aid, but do not meet the low to moderate income guidelines, please attach a letter to your
registration form stating your circumstances. These are special circumstances and will be handled
on a case-by-case basis.
13. Financial Support will be granted only if funds are available.
RRC’s Financial Support Program Application
Please complete all information. We reserve the right to verify all information contained on this form.
Applicant’s Name: ______________________________________________ Birth Date: ________________
Date of Initial Request: _______________ Date(s) of Additonal Request: _______________
Address: _____________________________________ City/St/Zip: ___________________________________
Home Phone:
Email___________________________________________________
*Email address will be used to notify applicant of the decision or if additional information is needed.
List number of family members living in household: _______
Please complete all information. We reserve the right to verify all information contained on this form.
Specifically List the Membership and/or Program, and Amount you are requesting. Request can NOT be made to
“hold” money, only requests for current programs will be processed. You may add until you reach the $50 limit,
no need to fill out new form staff can retrieve from file to add addiotnal requests to :
Applicants requesting financial support must meet at least one of the following criteria:
• 50 years of age and older and live in a low to moderate income household as defined by the Federal Department of
Housing and Urban Development (HUD).
• 62 years of age and older
Please note: All applicants seeking to qualify under the low to moderate income level must show proof of income by completing
HUD’s Self Certification Form. Please see back of form for income limits.
NOTICE: The application period is for the annual calendar year. Any change in income that would cause the applicant to exceed the
income eligible limits set forth by HUD will cause the applicant to no longer be eligible for this program unless the applicant’s income
level changes and meets the income eligible limits set by HUD. A new application form must be completed each calendar year in order
to verify that the applicant meets the current income eligible limits set by HUD. Please allow a period of at least five (5) business days to
determine scholarship eligibility.
Acknowledgement of Correct Information:
I acknowledge that the information contained on this application is accurate and correct. I hereby give permission to the
Farmington Parks and Recreation Department to verify this information. I understand that if any information on this
application form is found to be incorrect, my privileges of applying for financial support could be revoked.
Signature of Applicant: ___________________________________________ Date: _________________
FOR OFFICE USE ONLY
Participant New to FSP Yes/No Request is: ____Approved ____Denied
Date in Computer:_________________
Signature of Parks and Recreation Director or Designee Date
Quarter One Requests
Example: $35 membership
Quarter Two Requests Quarter Three Requests
Example: $6 Fun Friday
Quarter Four Requests
Example: $7 Rotary Christmas
Self Certification Form – 2016 (effective 03/28/16)
Dakota County CDBG Program
Information on annual family income and race is required to determine eligibility for public services funded with federal Community
Development Block Grant (CDBG) funds. Each participant must indicate the number of persons in their household, and then
CHECK THE BOX that contains the amount of annual family income.
INCOME is defined as the total annual gross income of all family and non-family members 18+ years old living within the
household. All sources of income must be counted from all persons in the household based on anticipated income expected within
the next 12 months.
Please check your Income Range based on your Family Size (for example if there are 5 people in your household, go to
HH of 5; if there are 8 or more in your household go to HH of 8):
Please calculate your total assets, including (a) checking, savings and other account balances; (b) tax assessed value of real estate
owned other than your home; (c) cash value/equity of any Life Insurance Policy; and (d) any other assets. NOTE: a percentage of
assets will be calculated by staff as part of income (example: $100,000 assets x 2.0% = $2,000).
Total Assets = $_________________
Please check your Ethnicity (pick 1 of 2): □ Hispanic or □ Non-Hispanic
Please check your Race (pick 1 of 10 choices):
Does your family have a FEMALE HEAD OF HOUSEHOLD? Yes No
Program or Activity Dates of Participation
Birth Date of Participant _________________________
APPLICANT STATEMENT: I hereby certify that the information on this form is accurate and complete. I understand that this self -certification may be
subject to further verification by the agency providing services, the City, the Dakota County CDA, or the U.S. Department of Housing & Urban Development. I,
therefore, authorize such verification, and I will provide supporting documents, if necessary. WARNING: Title 18, Section 1001 of the U.S. Code states that a
person is guilty of a felony for knowingly and willingly making false or fraudulent statements to any department of the U.S. Government.
Participant or Beneficiary Name (Please Print)
_____
Signature (Parent or Guardian, if participant is under 18 years old) Date
Household of 1: □ $0 - $18,050 □ $18,051 - $30,050 □ $30,051 - $46,000 □ $46,001+
Household of 2: □ $0 - $20,600 □ 20,601 - $34,350 □ $34,351 - $52,600 □ $52,601+
Household of 3: □ $0 - $23,200 □ $23,201 - $38,650 □ $38,651 - $59,150 □ $59,151+
Household of 4: □ $0 - $25,750 □ $25,751 - $42,900 □ $42,901 - $65,700 □ $65,701+
Household of 5: □ $0 - $28,440 □ $28,441 - $46,350 □ $46,351 - $71,000 □ $71,001+
Household of 6: □ $0 - $32,580 □ $32,581 - $49,800 □ $49,801 - $76,250 □ $76,251+
Household of 7: □ $0 - $36,730 □ $36,731 - $53,200 □ $53,201 - $81,500 □ $81,501+
Household of 8: □ $0 - $40,890 □ $40,891 - $56,650 □ $56,651 - $86,750 □ $86,751+
□ White □ Black or African American
□ Asian & White □ American Indian or Alaskan Native
□ Native Hawaiian or Other Pacific Islander □ Other
□ Black/African American & White □ American Indian/Alaskan Native & White
□ Asian □ American Indian/Alaskan Native & Black
City of Farm ington
430 Third S treet
F armington, Minnes o ta
651.280.6800 - F ax 651.280.6899
www.ci.farmingto n.mn.us
TO:Ramb ling River Center Advis o ry Bo ard
FROM:Randy Dis tad, Parks and R ecreatio n Direc tor
SUBJECT:2017 Farmingto n VFW Steak Fry F und rais er
DATE:January 9, 2017
INTRODUCTION
The annual Farmington VFW Steak Fry fund rais ing event will be held o n Saturd ay, January 21, 2017.
DISCUSSION
Staff wo uld like to dis c uss the S teak Fry fundrais ing event with Ad visory Bo ard members to s ee whic h
Advis o ry Board memb ers c an volunteer prio r to and during the event.
ACTION REQUESTED
No actio n reques ted, this item is for d is cus s ion and info rmational purp o s es o nly.
City of Farm ington
430 Third S treet
F armington, Minnes o ta
651.280.6800 - F ax 651.280.6899
www.ci.farmingto n.mn.us
TO:Ramb ling River Center Advis o ry Bo ard
FROM:Randy Dis tad, Parks and R ecreatio n Direc tor
SUBJECT:S taff Updates
DATE:January 9, 2017
INTRODUCTION
Staff report is for items s taff would like to update Advis o ry Bo ard members about.
DISCUSSION
Staff will provide a verb al up d ate o n the follo wing items:
2017 ap p ro ved b udget
2017 memb ers hips
ACTION REQUESTED
No actio n is b eing reques ted. These items are fo r info rmational purp o s es o nly.
City of Farm ington
430 Third S treet
F armington, Minnes o ta
651.280.6800 - F ax 651.280.6899
www.ci.farmingto n.mn.us
TO:Ramb ling River Center Advis o ry Bo ard
FROM:Randy Dis tad, Parks and R ecreatio n Direc tor
SUBJECT:Ad visory Board Round table Format
DATE:January 9, 2017
INTRODUCTION
The Ad visory Bo ard R o und table o cc urs at every mo nthly meeting.
DISCUSSION
The Ad visory Bo ard R o und table agend a item p ro vides an o p p o rtunity fo r Ad vis ory Board memb ers to share
informatio n or as k q ues tio ns o f staff about items that are not on the agenda.
ACTION REQUESTED
The Roundtable agend a item is fo r info rmatio nal p urposes o nly.
City of Farm ington
430 Third S treet
F armington, Minnes o ta
651.280.6800 - F ax 651.280.6899
www.ci.farmingto n.mn.us
TO:Ramb ling River Center Advis o ry Bo ard
FROM:Randy Dis tad, Parks and R ecreatio n Direc tor
SUBJECT:Items for February 13, 2017 Meeting Agend a
DATE:January 9, 2017
INTRODUCTION
This item is fo r s taff and the Ad visory Board to identify possible items fo r the next meeting agenda.
DISCUSSION
Thus far s taff has identified the following po s s ib le items for the F eb ruary 13, 2017 meeting agenda:
2017 Arts and Crafts S ale
Community Expo Review
Aging Mas tery P ro gram
ACTION REQUESTED
Advis o ry Board memb ers are b eing asked to c ome to the meeting prepared to dis c us s and id entify o ther items
fo r the February 13, 2017 meeting agend a.