Scholarship Form - Ymca (Page 2 of 2) in pdf

Scholarship Form - Ymca Page 2

PLEASE READ THE FOLLOWING BEFORE COMPLETING

THIS APPLICATION

We require the following documentation in order to process your application:

 A completed YMCA scholarship and membership application

 A copy of the most recent tax returns (1040 FORM). If you have not filed

taxes, please explain why and attach to this form. Proof of dependency for

children needs to be provided if no taxes are available.

 A copy of your most recent year-to-date pay stub for each member of the

household who is working.

 Documentation of SSI, SSD, SNAP, AFDC, unemployment, student loans, child

support, etc.

 If you are self-employed, please include your monthly bookkeeping documents.

 If there is any extenuating circumstances that are out of the ordinary, please

write a letter of explanation and attach to this form.

YOU MAY SUBMIT LETTERS FROM OTHER COMMUNITY ORGANIZATIONS FROM

WHICH YOU RECEIVE FINANCIAL SUPPORT, ALTHOUGH THEY CANNOT BE USED

AS A SUBSTITUTE FOR THE REQUESTED FORMS LISTED ABOVE. INCOMPLETE

APPLICATIONS WILL DELAY OUR ABILITY TO SERVE YOU.

PRIMARY ADULT (Required if applying for youth under 18)

First Name

Middle name

Last Name

Street Address

City

State

ZIP

Date of Birth

Phone Number

Email Address

Scholarship Form - Ymca Page 2