Financial Assistance Application

Financial Assistance Application

You MUST submit 1st page of 1040 tax form from last year AND 2 most recent paystubs AND upload a benefit letter declaring monthly income for each recipient, IF APPLICABLE. Please have these documents available and ready to upload to the form.
Please Note: A Eugene Family YMCA account is required BEFORE financial assistance can be awarded. If you do not already have an account, please begin the process by clicking here. Thank you!
Main Contact Name (to be completed by applicant or family/guardian, if applicant is under 18 yrs of age)*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Family Size
Household Size (total living in home)*
Number of Adults in Household*
Number of Youth in Household*
Please check the box for the Financial Assistance you are applying for?*

Facility MembershipChild CareHealthy Living: Blood Pressure Self-Monitoring/ Diabetes PreventionSummer CampYouth Programs: Swim, Tennis, Youth Sports

Please list all Adults living at your household*

Please list all Youth living at your household

Please list all sources of income (including spousal/child support, foster stipends, etc.) for the household*

Family Size