Minikani Financial Assistance Request

YMCA Camp Minikani Financial Assistance Application
We recognize there are times when some families are unable to afford a camp experience for their children. YMCA Camp Minikani has an Annual Campaign fund to provide financial assistance to those in need.

After completing this form, the camp office will contact you within two weeks of applying to confirm your campers eligibility and the amount of assistance your family will be eligible for. Please note that space can be limited in many of our programs, and if you would like to register your camper regardless of the level of assistance you may receive, please register your campers online or call our office at 262-251-9080. Please note that to hold a spot, a deposit is required at time of registration.

To complete this form, at minimum, you will need a copy of the first two pages of your most recent 1040 Federal Tax Form. Other helpful documents may include:
- Letter for each child confirming free/reduced lunch eligibility
- Supplemental Security Income (Food Stamps or Medicaid) award letter
- Public Assistance Benefit Card

How much assistance may be provided?

YMCA Camp Minkani Sliding Fee Scale
Gross Family Income	Total Number in Family
Gross Family Income	2	3	4	5	6	7+
$0 - $15,999	50%	60%	60%	60%	60%	60%
$16,000 - $21,999	40%	50%	60%	60%	60%	60%
$22,000 - $27,999	30%	40%	50%	60%	60%	60%
$28,000 - $32,999	20%	30%	40%	50%	60%	60%
$33,000 - $39,999	10%	20%	30%	40%	50%	60%
$40,000 - $45,999	0%	10%	20%	30%	40%	50%
$46,000 - $51,999	0%	0%	10%	20%	30%	40%
$52,000 - $59,999	0%	0%	0%	10%	20%	30%

Note: Percentages indicate typical amount of financial assistance given off of the cost of the session. No other discounts may be applied towards the fee. Extenuating circumstances may result in a higher or lower level of assistance.

Parent Name*

First NameLast Name
Phone Number*
Please enter a valid phone number
Phone Number Type*

HomeCellWork
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Total number of people in the family*
Number of Campers Attending YMCA Camp Minikani*

12345
My Camper(s):*

Are already registered for camp and I am requesting assistance.Are not registered, but I would like to get them registered/on the waitlist regardless of the outcome of this application. I understand a deposit will be collected.Are not registered, and registration will be dependent on the outcome of this application.

Supporting Documents
Describe Reason for Request and any extenuating circumstances your family may be facing.*
Please check all that apply:*

We have a Public Assistance Benefit CardWe receive Supplemental Security Income (Food Stamps or Medicaid)My child qualifies for free/reduced lunchNone of the above apply to us
Please upload any supporting documentation that you can:
- 1040 tax forms, pages 1 and 2 (required)
- Letter(s) confirming free/reduced lunch eligibility
- Supplemental Security Income (Food Stamps or Medicaid) award letter
- Public Assistance Benefit Card
Copy of your most recent taxes. Please upload at least the first 2 pages.*

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Copy of Public Assistance Benefit Card*

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Supplemental Security Income Award Letter*

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Proof of Free/reduced Lunch Eligibility - Please upload one letter for all campers on the application*

Cancelof
I hereby certify that the information provided on this application is accurate to the best of my knowledge and subject to verification by YMCA of Metropolitan Milwaukee. I understand that any misrepresentation or omission of a material fact on my application may be justification for refusal of financial assistance and that I agree to pay all remaining camp fees once enrolled by May 1.
Parent/Guardian Signature*

Clear
Should be Empty: