YMCA Youth Development Programming Scholarship Application

YMCA Youth Development Scholarship Application
Thank you for enrolling your Y-Kid(s) in one of our Youth Development Programs. We understand you are interested in our scholarship program to assist in defraying program fees.

After complete the following form, we can review your request and determine the amount of fee waiver. Select your current household's monthly income level, this will provide an immediate scholarship for the first week of programming. In order to receive the additional months for the summer, we require proof of monthly income or notification letter of receiving free and/or reduce meals at school district to our team at youthdevelopment@westcookymca.org by the 20th of the month that you are first approved. Any scholarships approved after the 20th, will begin the following month.

Parent/Guardian Name*

First NameLast Name
Parent/Guardian Birthdate*

MonthDayYear
Date
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Student 1 Name*

First NameLast Name
Student 1 Date of Birth*
Student 1 School*
What programming are you seeking scholarships for?*

School's Out SpecialsYMCA Adventure Camp
Do you need to add another student?*

YesNo

Student 2 Name*

First NameLast Name
Student 2 Date of Birth*
Student 2 School*
What programming are you seeking scholarships for?*

School's Out SpecialsYMCA Adventure Camp
Do you need to add another student?*

YesNo

Student 3 Name*

First NameLast Name
Student 3 Date of Birth*
Student 3 School*
What programming are you seeking scholarships for?*

School's Out SpecialsYMCA Adventure Camp
Do you need to add another student?*

YesNo

Student 4 Name*

First NameLast Name
Student 4 Date of Birth*
Student 4 School*
What programming are you seeking scholarships for?*

School's Out SpecialsYMCA Adventure Camp

Documentation for Scholarship Application

Please choose one of the following options below to continue your scholarship beyond the first month. If you do not submit today, our team will follow up within the first 30 days for you to submit, so that you can be approved for the remaining of the summer.
- Copy of Free/Reduce Lunch Letter from your school district
- Copy of 2 months of paystubs and/or SSI and/or Unemployment for the entire household
- Latest W2 for entire household
Before submitting, please ensure any social security numbers are blacked out.
Please choose your household's monthly gross income.*

$2750-$3250 for 20% scholarship$2250-$2749 for 30% scholarship$1500-$2249 for 40% scholarship$1499 and under for 50% scholarship
Upload Household Income Documentation or Free/Reduced Lunch Letter from School District. If you do not upload now, our team will follow up within the first 30 days for you to provide documentation.

Cancelof
By signing below, you understand and agree to the following:
- An email is required to receive a scholarship as this is the form of communication used by the scholarship team.
- Scholarships for YMCA Youth Development programming ranges from 20% to 50%. *Additional scholarships are available if a criteria is met
- To ensure contributions allocated to fund scholarships are being utilized for their intended use, scholarships are subject to be forfeited if the participant does not attend 75% of the program dates. The scholarship is forfeited, the weekly program tuition will be due in full on the Wednesday before the start of programming. Attendance will be checked weekly. Recipients will receive reminder emails to engage in the program, preferred 80% or higher attendance. All communications will be done through email.
- If for any reason a scholarship is terminated, the West Cook YMCA will make a good faith effort to communicate by the email address
Signature*

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Date*

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YMCA Youth Development Scholarship Application