YMCA of Greenwich Scholarship Application

YMCA of Greenwich Scholarship Application

Membership-For-All
Date*

MonthDayYear
Date
Applicant Information
Name*

First NameLast Name
Phone (Best # to call)*
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Household Residents

Please list all persons residing in Household
How many adults in household?*
How many children in household?
Parent/Guardian/Adult 1*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Parent/Guardian/Adult 2

First NameLast Name
Date of Birth

MonthDayYear
Date
Parent/Guardian/Adult 3

First NameLast Name
Date of Birth

MonthDayYear
Date
Child 1

First NameLast Name
Date of Birth

MonthDayYear
Date
Child 2

First NameLast Name
Date of Birth

MonthDayYear
Date
Child 3

First NameLast Name
Date of Birth

MonthDayYear
Date
Child 4

First NameLast Name
Date of Birth

MonthDayYear
Date
Child 5

First NameLast Name
Date of Birth

MonthDayYear
Date

Additional Information
Total Annual Household Income*
$
How Much Can You Afford to Pay For Membership Per Month:
$
How Much Can You Afford to Pay For Programs Per Session:
$
How Much Can You Afford to Pay For Camp Per Week:
$
How Much Can You Afford to Pay For After School Per Month:
$
Please Explain Reasons For Financial Assistance*

Income Document Upload (REQUIRED)

Application will NOT be reviewed without income documents. Please upload the most recent documents that show the current financial status of all working adults in your household. Check the box of each document you are providing.
Document Selection (please take photo or upload a PDF file)*

1040 Federal Tax Forms Page (Do NOT upload all tax pages)Last 3 Months of Pay StubsLetter From Employer (Containing Monthly Salary, Length of Employment and Employer's Name & Phone Number)Unemployed (Provide Appropriate Documents)
File Upload*

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