Please submit your information below. The Branch Membership Director may contact you for clarification on some of your answers.
(If applicant is under 18, the parent or legal guardian is the applicant.)
(List everyone living in the home.)
Below, please write a brief letter explaining how financial assistance will help; include any special circumstance, financial or otherwise. If one or more adults in the household are not receiving income, please explain how the remaining portion of fees will be paid.
Please submit the most recent copies of proof of income for all adults in the household. These can be IRS 1040 tax forms, W2s, proof of SNAP benefits, or documentation of your last 30 days of pay stubs/government assistance.
A photo is fine if you do not have access to a PDF or document scanner! If you do not have any of these things, please contact the branch Membership Director.
You can upload as many documents as you'd like for both of the next two questions. Just click "Choose File" for each new file you'd like to add!
I hereby certify that the information supplied herein is true, accurate, and complete to the best of my knowledge. I am also aware that it is my responsibility to immediately notify the YMCA in writing of any changes to information supplied in this application that may affect my eligibility for financial assistance such as income, address, living arrangements, marital status, etc. I understand that financial assistance is based on a sliding scale and that changes to my income may affect the amount of financial assistance that I qualify for. I understand that failure to comply with YMCA policies can result in immediate revocation of membership, financial assistance, and/or program privileges.