SCHOLARSHIP APPLICATION

SCHOLARSHIP APPLICATION
PROVIDING ACCESS FOR ALL
The Y exists to strengthen communities. With a commitment to nurturing the potential of kids, promoting healthy living and fostering a sense of social responsibility, the Greater Joliet Area YMCA ensures that every individual has access to the essentials needed to learn, grow, and thrive.
EVERYONE IS WELCOME
The YMCA welcomes all who wish to participate and believes that no one should be turned away due to the inability to pay. Through our scholarship program the Greater Joliet YMCA provides assistance to youth, adults and families based on individual needs and circumstances.
COMMITTED TO OUR COMMUNITY
Determining assistance is handled by YMCA branches in a fair and consistent manner. Every YMCA member receives the same membership benefits, regardless of whether or not they receive a scholarship. YMCA members can feel confident knowing that they are a part of an organization that cares greatly for the well-being of all people, and is committed to youth development, healthy living and social responsibility.

Upon approval, YMCA Scholarship reduces membership fees; it does not eliminate them. Award letters are valid for 45 days. The YMCA requests that individuals and families reapply at the end of your approval period with updated documentation. If you do not reapply at the time requested, your membership will expire.
Greater Joliet Area YMCA Scholarship Application
Scholarship Requested*

NewRenewal
Which Y will you utilize the most?*

C.W. Avery Family YGalowich Family YMorris Community Y
How did you hear about the Y?*
Which Y will you utilize the most:*

C.W. Avery YGalowich Family YMorris Community YSmith Family Y
HOUSEHOLD INFORMATION
Primary Adult*
first name, middle name, last name
Gender*
Birthdate:*

MonthDayYear
Date
Phone Number*

Area CodePhone Number
Email:*
example@example.com
Address*

Address

Street Address Line 2

CityState

Zip
Marital Status:*

MarriedDivorcedSeparatedSingleWidowed
Additional Household Members
Add additional household member*
Name*
first name, middle name, last name
Birthdate*

MonthDayYear
Date
Gender
Relationship to Applicant*
Add additional household member*
Name*
first name, middle name, last name
Birthdate*

MonthDayYear
Date
Gender
Relationship to Applicant*
Add additional household member*
Name*
first name, middle name, last name
Birthdate*

MonthDayYear
Date
Gender
Relationship to Applicant*
Add additional household member*
Name*
first name, middle name, last name
Birthdate*

MonthDayYear
Date
Gender
Relationship to Applicant*
Add additional household member*
Name*
first name, middle name, last name
Birthdate*

MonthDayYear
Date
Gender
Relationship to Applicant*
Membership Type

See Membership Brochure for descriptions on Membership types
*

Family PlusFamilyOne Adult FamilyTwo AdultAdult (ages 26 and older)Young Adult (ages 19-25)Youth (ages 0-18)
Please check all that apply:*

MembershipSwim LessonsSportsFitnessDancePreschoolSummer Camp (Required documents for Summer Camp: CCR&R application, or approval/denial letter. We do accept funds from the Child Care Assistance Program (CCAP). If you do not qualify for this program, YMCA Scholarship may be applied.)Before and After School (Required documents for Before and After School: CCR&R application, or approval/denial letter. We do accept funds from the Child Care Assistance Program (CCAP). If you do not qualify for this program, YMCA Scholarship may be applied.)
HOUSEHOLD INCOME & PROOF OF DEPENDENCY

All adults over the age of 18 requesting scholarship must provide proof of residency and verification of income regardless of relationship or varying interest in joining the YMCA.
Annual Household Income*
$ Dollar Amount
Proof of dependency for all dependents in the household is also required.
Acceptable Documents include:*

Federal Tax Return (1040) (If you claimed your child as a dependant)Birth CertificateGovernment Document with child’s name listedFoster Care Placement LetterCourt Document
Current Housing
*

I own my homeI rent my home
Monthly Mortgage*
$ Dollar Amount
Monthly Rent*
$ Dollar Amount
Use this space for additional information or extenuating circumstances that will help us understand your request for scholarship. I am requesting a YMCA Scholarship because...
EXPRESS VERIFICATION

We will accept the following for express verification. Additional information may be requested.
Select all that apply:

HUD/Section 8 - - - Accepted document: Statement LetterCCAP (Child Care Assistance Program) - - - Accepted document: CCAP Approval LetterTANF (cash assistance)/SNAP (Food Stamps) - - - Accepted document: Notice of Decision Letter
Need help accessing your documents? If you receive aid from one of these programs but need a copy of your approval letter, please contact your case worker or visit www.abe.illinois.gov. For a copy of your CCAP approval letter go to the Child Care Resource and Referral Office.
STANDARD VERIFICATION (only complete if not using Express Verification)
Did you file taxes?*

Yes - Most Recent Federal Tax Return: first 2 pages of form 1040, 1040a or 1040ez (Self employed individuals must include Schedule C)No - If a Federal tax return is not available, you must provide one of the following:
Check all that apply and provide the supporting documentation with this application.
*

IRS Verification of non-filing letter (this can be obtained by calling 1-800-TAX-FORM and it will be mailed within 5-10 days or go to IRS.gov for immediate access to your tax transcripts)Check Stubs (2 most recent)Letter from Employer on company letterhead (stating your pay rate and weekly hours worked)Income Verification Form (CCR&R Form)Earned Income Statement (Earnings Record) This document can be obtained at www.socialsecurity.gov/myaccountUnemployment (proof of weekly benefit amount)
Other Income (please supply proof of all that apply)
Social Security (SSI) Disability/Retired/Survivor Benefit Statement*
$ Dollar Amount
401(k) or 403(b) Retirement distribution statement (1099 R)*
$ Dollar Amount
Disability or Pension Benefit Document (1099 R)*
$ Dollar Amount
Child Support/Alimony*
$ Dollar Amount
Aid for Dependent Children*
$ Dollar Amount
TANF (cash assistance) / SNAP (food stamps)*
$ Dollar Amount
When above documentation is not available, a written reference on organizational letterhead from a refugee agency, agency that assists homeless, or other community organization who has a close relationship with the applicant with knowledge of the applicants income status may be used. Visa information for international students and I.D. cards issued by Governments outside of the U.S. may be accepted.

Applications received without documentation attached will be delayed.
I certify that the above information is true and complete to the best of my knowledge, and I do not have additional income not represented in the above statements. I understand that scholarship assistance is based on need and is determined by using a sliding fee scale. In the event that I or my children must cancel our participation, I will contact the YMCA immediately so scholarship assistance 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. I understand that my membership can be terminated should I not comply with YMCA rules and policies. Membership fees are subject to change.
Applicant Signature*

Clear
Date*

MonthDayYear
Date
Please attach all required documents*

Browse Files

Cancelof
Attach copies of all applicable documents. Please allow 7-10 business days for processing.
Plainfield Township Residents: Plainfield Township offers a General Assistance program which provides monthly financial assistance to persons who are not eligible for any other state or federal assistance programs, and who do not have adequate income or resources to provide for their own basic needs. Any township resident, 18 years or older, who is either a U.S resident or legal alien admitted under the color-of-law, is eligible. The General Assistance Program is primarily for those adults without minor children without adequate income, and ineligible for any other monetary form of assistance.

If you are interested in applying for this program, please click the link on the following Thank You page after submitting this Scholarship Application.
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SCHOLARSHIP APPLICATION

PROVIDING ACCESS FOR ALL

EVERYONE IS WELCOME

COMMITTED TO OUR COMMUNITY