Financial Assistance Application

ELIGIBILITY

Eligibility is determined by household income and number of qualified dependents. Assistance will be granted on the basis of financial need. All fees are to be kept confidential, as they are specific to individual and family circumstances. In order to qualify for financial assistance towards childcare, including the Early Childhood & Youth Development Center or Y Afterschool programs, all adults in the household must demonstrate employment or a status of full-time student or its equivalent. The Y believes that a strong sense of ownership and pride is developed if the financial assistance recipient contributes to the cost of their Y involvement. Therefore, all applicants will be required to pay a portion of program fees.

Failure to provide required / requested documentation may delay or void your application.

SPECIAL CIRCUMSTANCES

Each application and circumstance is independently reviewed. If you feel there are special circumstances that may be a factor in this decision, you may provide your written explanation and any supporting documentation with this application. In order to most accurately assess each situation, and to assure that we are providing assistance to people who need it most, we may request additional documentation to support your application. While our branches and programs work together towards a common mission, eligibility for financial assistance may be specific to a program or location. Some information may be shared in confidence between decision-makers at our branches to ensure the most accurate review of your situation and programs that would most benefit your family.

In addition to this list, additional documentation or supporting
Failure to provide required / requested documentation may delay or void your application.
Return your completed application and documentation to your local YMCA of Greater Montgomery branch or service location.

*NOTE: If you do not have a copy of your tax return, you may obtain one by calling the Internal Revenue Service at 1-800-829-1040. If you did not file taxes last year, or if you do not have the other documents required, please explain your personal situation on the application form.

In addition to this list, additional documentation or supporting information may be requested for application consideration.

First Page of Tax Return Upload*

Drop files here or

Accepted file types: txt, csv, xm, jpg, pdf, png, Max. file size: 20 MB.

Attach a copy of first page of your latest tax return. (*required to apply, will be deleted after application process)

If Applicable Attach the Following Documents

Last Two Current Paycheck Stubs

Drop files here or

Max. file size: 20 MB.

Copy of Class Schedule (if Student)

Drop files here or

Max. file size: 20 MB.

Documentation of Social Security or Disability

Drop files here or

Max. file size: 20 MB.

Documentation of Other Subsidized Income (food stamps, rent subsidy)

Drop files here or

Max. file size: 20 MB.

Copy of Child Support / Alimony, Proof of a Pending Case with the Attorney

Drop files here or

Max. file size: 20 MB.

General’s Office or Documentation that You DO NOT Receive Child Support

Drop files here or

Max. file size: 20 MB.

List all persons living in household (including yourself, other adults and all children). All household members may not be eligible for Financial Assistance.

Name (First / Last)*

School / Employer*

Birthdate*

Age*

Gender*

Add Household Member

Add Member

Name (First / Last)*

School / Employer*

Birthdate*

Age*

Gender*

Add Household Member

Add Member

Name (First / Last)*

School / Employer*

Birthdate*

Age*

Gender*

Add Household Member

Add Member

Name (First / Last)*

School / Employer*

Birthdate*

Age*

Gender*

Add Household Member

Add Member

Name (First / Last)*

School / Employer*

Birthdate*

Age*

Gender*

Add Household Member

Add Member

Name (First / Last)*

School / Employer*

Birthdate*

Age*

Financial Important Information

Timetable*

Per Week

Per Month

I can afford to pay (per week)*

I can afford to pay (per month)*

Have you received financial assistance in the past?*

Yes

No

What was the date of your most recent scholarship and what Y program did you participate in:

Date / Year*

Program*

Please explain if you cannot provide documentation of your household income

THE FOLLOWING GUIDELINES MUST BE FOLLOWED TO CONTINUE ANY ASSISTANCE

Once assistance is approved, you have 1 WEEK to accept or you must re-apply.
Payments must be paid in full and on time.
If your payment results in a non-sufficient funds (NSF), you will be allotted the appropriate time to rectify the payment. If payment is not made, you will be dropped from all Y programs.
It is the applicant’s responsibility to re-apply when funding expires.

Signature*

Your signature indicates that you have read and understand the policies and principles of the Y Financial Assistance Program.

CAPTCHA

ELIGIBILITY

SPECIAL CIRCUMSTANCES

If Applicable Attach the Following Documents

Applicant's Information

Other Adult In Household Information

Demographic Information

Employment/Wages

Child Support

Alimony

Unemployment

Food Stamps

AFDC

SSA/SSl

Parental Support

Housing Subsidy

Worker's Comp.

Other

Employment/Wages

Child Support

Alimony

Unemployment

AFDC

SSA/SSl

Parental Support

Housing Subsidy

Worker's Comp.

Others

Financial Important Information

What was the date of your most recent scholarship and what Y program did you participate in:

THE FOLLOWING GUIDELINES MUST BE FOLLOWED TO CONTINUE ANY ASSISTANCE