Y Membership For All Financial Aid Application Form
Download a blank fillable Y Membership For All Financial Aid Application Form in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Y Membership For All Financial Aid Application Form with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1Y Membership for All
Financial Aid Application
The YMCA is committed to helping everyone access to the services we provide. That’s why we base membership and program fees on total
household income. This sliding fee scale, made possible thanks to donor contributions, allows us to reflect the multicultural, ethnic, and racial
diversity of our service area. We strive to create an environment where all people feel welcomed and valued. To be eligible for a
scholarship, applicants must work or reside in the YMCA of Greater Pittsburgh service area and meet household/yearly income
requirements. Those not able to pay the full fee may be awarded assistance based on their demonstrated ability to pay. The
YMCA believes a strong sense of ownership and pride is developed when the recipient contributes to the cost of their YMCA involvement;
therefore, applicants pay some portion of the fees. Applicants are notified once the application has been reviewed. *Eligibility: Financial
assistance is available to anyone based on family income, number of household members, and the availability of Y funds. Awards are provided
fairly and openly on a first come, first served basis. The YMCA reserves the right to refuse assistance to any applicant.
To apply for a scholarship, please bring the following information to any YMCA Welcome Center.
This includes assistance with online program registrations. To process your application, please provide the following information:
• Program Registration completed online
• Confidential Financial Assistance Application (download PDF)
• Copy of last year's tax return *
• Copy of current pay stub OR Copy of social security or disability check
*If you do not file a tax return, call the IRS at 800.829.1040 or go to to download Form 4506-T and request a Verification for a Non-filing
letter to submit in lieu of the tax return. Then you provide additional proof of any income (i.e. child support, food stamps, etc.).
The Y reviews the application to determine your financial assistance eligibility. Your local branch contacts you, if the award is approved.
Parent/Guardian First Name
Parent/Guardian Last Name
Date of Birth
M/F
Program(s) Requested
Family Member First Name**
Family Member Last Name
Date of Birth
M/F
Program(s) Requested
**Any additional family members should be written on the back of this form. All family members who want to be considered must be included on the provided income tax return information.
Address ___________________________________________________________________________________________________
City _______________________________________
State _________________________
Zip _________________
Phone (Work) _______________________ (Cell) ____________________________ (Home) _____________________________
Email Address ________________________________________________________
Ethnicity: African American ___ Asian ___ Caucasian ___ Latino/Hispanic ___ Other ____
Please indicate: Number of household members: _______ Adjusted Gross Income (per tax return) $ ______________
Any Extenuating Circumstances to be considered:
______________________________________________________________________________
______________________________________________________________________________________________________________________________________
Welcome Center Staff Use Only
I certify that the above information is true and complete to the best of my knowledge. I
Date application received _______________
agree to inform the YMCA immediately of any change in my income or family size. I
A Verified by _______ (1
st
staff initials)
understand that false or incomplete information could jeopardize my scholarship.
Verified by _______ (2
nd
staff initials)
Signed _______________________________________ Date ________________
Office Use Only: □ ( _____ %) Approved □ Denied
Additional Notes to File:
Staff Signature__________________________
_________________________________________________________________________
Date __________________
_________________________________________________________________________
□ Applicant contacted □ Entered in CLASS
_________________________________________________________________________
3-16-2015
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial