Decatur Shelby County YMCA Scholarship Application
Financial Assistance Application Instructions:
1. Complete the Application
Fill out the form in its entirety and be sure to include ALL members of your household and their dates of birth.
2. Provide Required Documentation
Submit documentation showing all income and/or assistance your household receives monthly. Acceptable documentation includes: pay stubs, social security income, SNAP or WIC benefits, child support orders, or any other form of income/assistance. Please Note: Applications cannot be processed without documentation.
Documentation can be attached at the bottom of this form.
3. Submit Your Application
The application can be submitted to the YMCA through this form.
4. Application Review
Your application will be assessed based on where your household's monthly income falls within our financial assistance parameters. This process takes between 7-14 business days.
5. Scholarship Notification
You will receive a voucher letter or email with the results of your application. To redeem your scholarship, you must bring the voucher letter to the front desk within 30 days of receipt. At this time you will need to and, fill out a membership application and make your first payment. Participants will be responsible for paying the remaining cost of the membership and/or program fees not covered by the scholarship.
6. Ongoing Eligibility
If enrollment drops or payments are not made in a timely manner, the scholarship may be revoked.
7. Scholarships are reassessed on an annual basis.
8. Exclusions
Financial assistance does not apply to the following: personal training, private swim lessons, key fob purchase, and childcare registration fees.
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Decatur Shelby County YMCA Scholarship Application
Primary's Name:
First Name
Last Name
D.O.B:
-
Month
-
Day
Year
Date
Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone:
Format: (000) 000-0000.
Which YMCA branch is this scholarship request for?
*
Decatur County Family YMCA
Shelby County YMCA
Email:
example@example.com
Please select which type of Membership or Program for which assistance is requested for:
Household
Adult
Youth
Senior
Childcare
Swim Lessons
Other Youth Programs
Household Members - Please list EVERYONE within your household and their dates of birth.
Rows
First Name
Last Name
Date Of Birth
1.
2.
3.
4.
5.
6.
7.
Upload Supporting Documentation Here:
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Please submit documentation showing all income and/or assistance your household receives monthly. Acceptable documentation includes: pay stubs, social security income, SNAP or WIC benefits, child support orders, or any other form of income/assistance. Please note, applications cannot be processed without documentation.
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of
Monthly Income:
Rows
Adult 1
Adult 2
Total Gross Earnings from work:
Number of Pay Periods Per Year (12, 24, 26, or 52):
Social Security Income/Retirement:
Unemployment or Worker's Comp:
Child Support:
SNAP, WIC, or Other Govt Program:
Other Income:
Total Monthly Gross Income (After entering each income amount above, please calculate the total for each adult and enter it here):
I hereby certify that the information supplied herein is true and complete to the best of my knowledge. I understand that if paycheck stubs and tax returns are not submitted with the application, it may cause a delay in the financial assitance process timeline.
Applicant's Signature:
Date:
-
Month
-
Day
Year
Date
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