YMCA Financial Assistance Application

MEMBERSHIP FOR ALL

YMCA OF VINCENNES
The Essence of the Y

With commitment to nurturing the potential of kids, promoting healthy living and fostering a sense of social responsibility, the YMCA of Vincennes ensures every individual has access to the essentials needed to learn, grow and thrive.
Everyone is Welcome

The YMCA welcomes all who wishes to participate and believes no one should be denied access to the Y based on their ability to pay. Through our Annual Campaign, the Y provides assistance to youth, adults, and families based on individual needs and circumstances.
Committed to Our Community

Determining your level of support is handled by the Y in a fair and consistent manner. YMCA members can feel confident in knowing they are part of an organization who cares greatly for the well-being of all people and is committed to youth development, healthy living and social responsibility.
Please Note
- Campaign reduces membership and program fees; it does not eliminate them.
- Support is awarded based on household size and annual income. All support will be granted for 1 year.
- Membership and program fees are subject to change upon review.
- Members are responsible for payments for the duration of the membership.
- A 10 day notice is required to cancel membership for any reason.
  
  Support is granted following a review of all documentation. The Y reserves the right to request additional information when necessary.

I Am Applying For:
Circle the category for which you are applying.

Household (2 Adults plus Children)Adult (24+)Senior Household (2 adults 60+)Senior (60+)Young Adult (19-24)Youth (0-18)Walking (19+)
Provide ONE of the Following Options:
I filed federal taxed for last year.

Yes - See belowNo - Please provide a statement of non-file form AND social security benefit statement or most recent pay stub.
If yes, did you file 1040 Federal Tax Form(s) for all incomes in household
If your household income changed since you filed taxes last year

Include current federal tax forms and explanation for reason of income.
Monthly income $blanks X 12 months = $ blank total annual household income. (INCLUDE CHILD SUPPORT & GOVERNMENT ASSISTANCE).

Income*

Expenses*

How will you benefit from a Y membership?*
I certify the above information is true and complete to the best of my knowledge, and 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 subsidy assistance is based on need. In the event I, or my children must cancel our participation, I will contact the YMCA immediately so sponsorship can be provide to others. I understand that if I falsity any of the above information, I will not be eligible for assistance now and/or in the future.
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MEMBERSHIP FOR ALL