Affordable for All Financial Aid Application

Affordable for All Scholarship Application

Strengthening Community is our Cause

Every day, we work side-by-side with our neighbors to make sure that everyone, regardless of age, income or background, has the opportunity to learn, grow and thrive. At the Y, no child, family or adult is turned away. We recognize that for communities to succeed, everyone must be given the opportunity to be healthy, confident, connected and secure.

At the Y, we believe lasting personal and social change can only come about when we all work together to invest in our kids, our health and our neighbors. YMCA financial assistance is made possible through generous donations from individuals and foundations opening a world of YMCA programs and activities for you and your family including: membership, youth sports, teen programs, youth programs, parent/child programs, childcare, camps and more.

Apply for Affordable for All financial aid in FIVE easy steps!

STEP 1:

Name*

First Name

Last Name

Email*

Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Phone*

Secondary Phone Number

If applicant is under 18: Parent or legal guardian's name and emergency contact below:

YMCA of Greater Whittier branch:*

Uptown Whittier YMCA East Whittier YMCA

STEP 2:

List All Persons Living in the Household

Parent/Guardian/Adult 1:

First Name

Last Name

Date of Birth:

Check one:

Male Female

Are you applying for assistance for this person?

Yes No

Parent/Guardian/Adult 2:

First Name

Last Name

Date of Birth:

Check one:

Male Female

Are you applying for assistance for this person?

Yes No

Child 1:

First Name

Last Name

Date of Birth:

Check one:

Male Female

Are you applying for assistance for this person?

Yes No

Child 2:

First Name

Last Name

Date of Birth:

Check one:

Male Female

Are you applying for assistance for this person?

Yes No

Child 3:

First Name

Last Name

Date of Birth:

Check one

Male Female

Are you applying for assistance for this person?

Yes No

Child 4:

First Name

Last Name

Date of Birth:

Check one:

Male Female

Are you applying for assistance for this person?

Yes No

Child 5:

First Name

Last Name

Date of Birth:

Check one:

Male Female

Are you applying for assistance for this person?

Yes No

Other Dependent:

First Name

Last Name

Date of Birth:

Check one:

Male Female

Are you applying for assistance for this person?

Yes No

STEP 3:

Other:

Please list above

STEP 4:

Please provide the following documents:

I filed general taxes for last year

I am an individual filing jointly; I am providing ONE 1040 form We filed MORE THAN ONE tax form in our household I did not file federal taxes for last year

If you filed more than one tax form in your household, how many are you providing?

Please attach tax returns

No File Chosen

File uploads may not work on some mobile devices.

Current Income

My household income has changed since I filed taxes last year I am attaching documents showing 2 months of income (including pay stubs or documentation of government assistance

Current Income

Total Annual Household Income for 12 Months

Please attach documents showing 2 months of income

No File Chosen

File uploads may not work on some mobile devices.

THIS APPLICATION MUST BE RENEWED EVERY TWELVE MONTHS.

I certify that the above information is true and complete to the best of my knowledge, and that I do not have additional income not represented above. I agree, if necessary, to send additional information and documentation to support the above statements. I understand that sponsorship assistance is based on need. In the event that I or my children must cancel our participation, I will contact the YMCA immediately so sponsorship can be provided to others. I understand that if I falsify any of the above information, I will not be eligible for assistance now and/or in the future.

This partnership is a commitment of the YMCA and the member to each pay a portion of the membership fee for 12 months. If after 12 months the member is still in need of the income-based membership payment plan, it is the member's responsibility to reapply; otherwise, your financial assistance award will expire and your membership auto-draft payments will adjust to our regular membership fee category which you initially applied for. All membership fees are non-refundable and non-transferable.

Membership fees are subject to change when you reapply annually.

STEP 5:

Signature of person completing this form*

[clear]

Use your mouse or finger to draw your signature above

Date

If you did not submit financial documents with this form, please bring them in to the YMCA Welcome Center. Note that incomplete applications, or applications submitted without proper supporting documentation cannot be reviewed. All records are kept confidential. Payment plans are available. Applications may take up to two weeks to process. All applications are subject to approval, based on eligibility and availability of funds.