YMCA Financial Assistance Program Application

In these uncertain times, we don’t want anyone to be turned away from the YMCA and this program will help you and your family take part in everything the Y has to offer.
We believe the Y is here to make our community a better place for all.

Head of Household

MM slash DD slash YYYY
MM slash DD slash YYYY
Address

Who Are You Applying For?

List the names of the family members and date of birth

What Are You Applying For?

Check all that apply.
Membership
Program Requested
Childcare
Summer Camp
Location

Proof of Income (Gross Wages, Unemployment/Child Support/Alimonty, Total Income)

Needs to be dropped off at your Branch Location at the Front Desk to the attention of the Audrey Bowles or emailed to abowles@cyedc.org

Statement Of Need

(In the space below, please describe the reason and need for financial assistance.) I am willing to share my YMCA Cares experience to help educate the community on the financial assistance program and how it has benefited me and/or my family. I understand that this is voluntary and my name as well as the names used in this statement will be changed and kept confidential. I am aware that the purpose of this statement is to assist the Y in their educational fundraising efforts.