YCares Financial Assistance Application

The YMCA strives to make our programs and membership available to all who will benefit from them, regardless of their ability to pay. All financial assistance is granted on a sliding scale based on income and need. All information is kept confidential.

Please fill out the form below to see if a membership scholarship may apply to you. Verification of income will be required to confirm eligibility. The Y utilizes a third-party data aggregator that analyzes 100s of data sources to build an estimated household income for over 300 million people. It's an easy way for us to quickly qualify people and will not affect your credit score. If the system is unable to verify your household income, we will ask that you provide income documentation to be qualified through our standard process (see below). 

Primary Applicant Information
Name
Date of Birth
Address
City
State
Zip
Email
Cell Phone Number
Employeer
Occupation

Second Adult Applicant Information
Name
Date of Birth
Address
City
State
Zip
Email
Cell Phone Number
Employeer
Occupation

Assistance Request
What kind of membership are you interested in?
 Youth  Adult  Family
 
What programs are you interested in?
 Sports  Aquatics  Enrichment
 After/Before Care  Summer Camp  Other
 

Household Information
How many people are in your household?

Monthly Income Information

Please fill in your monthly income as accurately as possible. If you already know your total monthly income, just put that number in the "other" input box to see your calculation.
Use numbers only. No dollar signs ($), periods (.), commas (,) or letters. Thank you.
Number of Family Members
Monthly Wages, Salaries, Tips for you (before taxes)
Monthly Wages, Salaries, Tips for your Second Adult (before taxes)
Monthly Unemployment compensation you receive
Monthly Social Security compensation you receive
Monthly Child Support you receive
Other monthly income you receive
(e.g. Food Stamps, Aid to Dependent Child, 401K, Alimony, etc).
Monthly Income
Annual Income

Additional Information
Please inform us of any special circumstance that affects your income Examples; recent unemployment, medical bills etc.

 

*If we are unable to verify your household income through the third-party aggregator, the following documents will be requested and must be delivered to the Y within one (1) month for your application to be considered:

Income Information for All Adults in the Household:

  • Most Recent Income Tax Returns (Form 1040 pages 1 and 2 ONLY; or 1040EZ)
  • 2 Most Recent Paystubs     
  • Unemployment                                  
  • SSI 
  • SNAP                          

Housing Information:

  • Lease or mortgage statement show monthly payment
  • TANF / Section 8 Assistance (if applicable)

Unfortunately, budgetary demands limit the number of families that we can assist. If you are unable to submit the required documents within one (1) month to complete your application process, we will understand that you do not wish to participate in this program at this time. To protect your confidential information, your application will be safely discarded. Should you wish to reapply, our policy requires a waiting period of six months and that you resubmit all current financial data when re-applying.