Financial Assistance Application

YMCA Cares - Financial Assistance Application

YMCA Cares - Financial Assistance Application

YMCA Mission

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.

General Guidelines

  • Any outstanding balances must be paid in full before Financial Assistance will be granted.
  • Persons, who meet the qualifications for subsidy from government agencies (CCIS), will be referred to those agencies before Y CARES Financial Assistance is granted.
  • All Financial Assistance grants will be documented for reporting purposes.
  • Recipients of private grant funding for Y participation are not eligible for YMCA CARES.

APPLICATION PROCESS

  • Complete all the information requested on the YMCA CARES financial assistance application.
  • Provide the following required information to process your application:
    1. Page 1 of your 1040 Income Tax form for the most recent year (showing dependent child(ren)
    2. Last two pay stubs of everyone in the home who is working
    3. Proof if Social Security or Social Security Disability Income (if applicable)
    4. Proof of other sources of income, if applicable (e.g. Unemployment Compensation, Food Stamps, Worker’s Compensation, Child Support, Alimony, Access, SSI, Student Loans, etc.)

Very Important

  • Your application will not be processed and will be returned to you if any information is missing or incomplete.
  • Please allow 2-4 weeks to process your application.
  • All financial assistance information is handled in a confidential manner and will only be seen by reviewing YMCA staff.
  • YMCA Financial Assistance is made possible by the generous contributions of our donors to the YMCA Annual Campaign. All funds raised through this campaign go directly to the Financial Assistance program.
  • Questions about this application, contact Dana Ridpath at 610.638.1270 ext. 3031 or email dridpath@cyedc.org.

Applicant Information

Adult Applicant Information

City
State/Province
Zip/Postal

Adult Co-Applicant

Adult Co-Applicant

City
State/Province
Zip/Postal

Financial Information

Financial Information

Monthly Amount
Monthly Amount
Monthly Amount
Monthly Amount
Monthly Amount
Monthly Amount
Monthly Amount
Monthly Amount
Monthly Amount

ATTACH PROOF OF ALL INCOME

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.

Upload all information in a .zip folder, can't upload seperately!

Drop a file here or click to upload Choose File
Maximum upload size: 10.49MB

Dependents

Dependents


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.

* Required


Statement

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.

Sending