The Community YMCA of Eastern Delaware County is a charitable association, dedicated to building healthy spirit, mind and body. We are committed to being a positive part of family life by promoting the values of caring, honesty, respect and responsibility.
Including two recent paycheck stubs for all wages listed below, page one of
your completed 1040 Income Tax form for the most recent year and copies of all other types of income.
(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.
To the best of my knowledge, all the information in this application is true and complete. I realize the Y’s financial resources are limited and therefore, I may be asked to seek additional funding from other sources. I will immediately notify the Y of any changes that might affect my financial status. I accept the responsibility to make scheduled payments on or before the due dates. I will contact the Y if I cannot make a payment on time. I realize that failure to make payments on time and/or to contact the Y regarding payments due, will result in the loss of any assistance granted. I also recognize that as a result of financial contributions made to the Y, my participation has been made possible. I agree to support the Y’s policies, program and staff.