Financial Assistance

EVERYONE IS WELCOME

Income-based rate applications are handled by the Y in a fair and consistent manner and will be approved within 10 business days of submission.

The YMCA welcomes all who wish to participate and believes that no one should be denied access to the Y based on their inability to pay. Through our annual campaign, the Y provides income-based rates to youth, adults, and families based on household income and household size.

We handle applications fairly and consistently. Please note that incomplete applications will not be processed. The YMCA reserves the right to request additional information if necessary.

The processing time for a completed application is 10 business days.

We utilize a sliding fee scale based on total household income and the number of household members.

Supporting documentation is required to verify household size and income, and we take special circumstances into account when providing assistance.

The approved discount will reduce membership and program fees but not eliminate them. Financial Assistance rates are approved for a certain period of time, depending on circumstances. If you do not reapply by the given expiration date, fees could increase to the full rate or account termination.

Please fill out the form below honestly and accurately.

Application Form

First Name

Last Name

Date of Birth

Gender

Phone

Street Address

Apt. Number

City/Town

State

Zip Code

Occupation

Length of Employment

Second Adult Full Name

Date of Birth

Gender

Phone

Occupation

Length of Employment

List all of additional adults with their dates of birth in your household.

List all of your children with their dates of birth in your household.

Tell us about more, please share your story.

Tax Returns, please submit your most recent federal tax returns (Form 1040 pages 1 and 2 only, or 1040 EZ). If you do not file federal income taxes, please call 1-800-TAX-FORM (1-800-829-1040) for verification of non-filing or visit IRS.gov for additional information. If you are unemployed, draw social security, or are a full-time student, please provide a summary of your unemployment benefits, SSI paperwork, or financial aid benefits and student schedule. You may upload up to four files. Please make sure you have marked over personal data information such as social security numbers. Supporting Files: gif, jpg, png, pdf. Limit: Four files and 10 MB.

Agreement

I certify that this information is true and complete to the best of my knowledge. I grant permission to the YMCA to verify this information. I agree to notify the YMCA if my financial status should change.

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EVERYONE IS WELCOME

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