Fillable FINANCIAL ASSISTANCE YMCA OF GREATER WAUKESHA COUNTY

Fill Online, Printable, Fillable, Blank FINANCIAL ASSISTANCE YMCA OF GREATER WAUKESHA COUNTY Form

Use Fill to complete blank online OTHERS pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

FINANCIAL ASSISTANCE YMCA OF GREATER WAUKESHA COUNTY

On average this form takes 19 minutes to complete

The FINANCIAL ASSISTANCE YMCA OF GREATER WAUKESHA COUNTY form is 2 pages long and contains:

  • 1 signature
  • 26 check-boxes
  • 60 other fields

Country of origin: OTHERS
File type: PDF

BROWSE OTHERS FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
• The YMCA conducts regular sex offender screenings on all members, participants,
and guests. If a sex offender match occurs, the YMCA reserves the right to cancel
membership, end program
participation, and remove
visitation access.
• Membership add-ons are
not eligible for nancial
assistance.
• Applicants applying for
a household membership
will need to provide
verication of income
for all adults in the
household.
• Some programs are not
eligible for Financial
Assistance.
To apply for nancial assistance, please review the following
requirements, ll out the application on the back, and include
the required documentation.
Application Requirements:
• Applicants must ll out the Financial Assistance Application
and provide verication of all income and/or assistance
received. Applications are kept condential.
• Please include a brief note describing how a YMCA
membership would benet you and/or your family. Please
also include any special or extenuating circumstances
(divorce, medical bills, etc.)
• Applicants must work or reside in the YMCA of Greater
Waukesha County service area.
• Assistance may be granted on the basis of nancial need
such as low income, number of dependents, extenuating
circumstances, etc.
• The YMCA believes a sense of ownership and pride is
developed if the nancial assistance recipient has contributed to the cost of their YMCA involvement. Therefore, applicants
will be asked to pay a portion of the membership or program.
• Foster parents must submit proof of household income along with assistance granted for the foster child.
The mission of the YMCA of Greater Waukesha County is to put Christian principles into practice through programs that
build healthy spirit, mind, and body for all. Through the generosity of our members, staff, and community, we are able to
provide nancial assistance for kids and families who need us most. We want to help people of all ages and from all walks
of life be more healthy, condent, connected, and secure.
FINANCIAL ASSISTANCE
YMCA OF GREATER WAUKESHA COUNTY
LIST OF REQUIRED DOCUMENTS
Most recent year’s Federal Tax Return (Form 1040 pages
1 and 2 only; or Form 1040EZ) or a non-ling form.
Copies of your last three paycheck stubs OR a letter
from your employer stating your annual salary.
Copies of all applicable supporting documentation listed
in the Income Verication Information box listed on
back.
Letter about how nancial assistance would benet you
and/or your family, including any special or extenuating
circumstances.
Photo ID of all applicants 18 years and older.
BUSINESS DESK STAFF
Date Received by Business Desk Business Desk Staff Initials
OFFICE USE ONLY
Member Number Membership Type
Amount Per Month $ % Off Per Month Programs Included Yes No
Date Received Staff Initials
Date Processed Valid Until
1 APPLICANT INFORMATION
Full Name (First, Middle, Last) DOB GENDER
Home Address
City State ZIP Code
Primary Phone Number
Secondary Phone Number
Email for Registration
Employer
Work Phone
Hours worked per week Salary or hourly wage
Spouse/Signicant Other’s Full Name (First, Middle, Last) DOB GENDER
Spouse or Signicant Other’s Employer
Work Phone
Hours worked per week Salary or hourly wage
FINANCIAL ASSISTANCE APPLICATION
Today’s Date
I am a new applicant to the Financial Assistance Program.
I am reapplying for the Financial Assistance Program.
4 INCOME VERIFICATION INFORMATION
Please list the monthly totals for income and/or assistance received by your
household. Verication of these amounts is required. You must provide your
most recently led Form 1040s or Verication of Non-Filing (Form 4506-T).
Monthly Total $ N/A or Do Not Receive
Household Gross Income
Food Share and/or WIC
Unemployment
Child Support/Alimony
WI Shares/Childcare Subsidy
Housing Subsidy (Please list the
amount of assistance that you
receive, not the amount you pay.)
Energy Assistance
Social Security Disability
Supplemental Social Security
Social Security
OTHER
5 SIGNATURE
I afrm to the best of my knowledge that the above
information is true and complete. I agree to provide income
documentation as requested. I understand that this nancial
assistance is short term and that nancial assistance eligibility
is reassessed annually unless otherwise noted.
Signature of Financially Responsible Member Date
3 I AM APPLYING FOR
Household
Senior Two Adult (65+)
Senior Adult (65+)
Adult (30-64)
Young Adult (18-29)
Youth/Teen (8-17)
MEMBERSHIP
PROGRAMS
Child Care
Camp
Before/After School Care
Preschool/4K
Swim Lessons
Youth Sports
Other, please specify
2 OTHER PERSONS LIVING IN THIS HOUSEHOLD
(Add additional paper if necessary.)
Full Name (First, Middle, Last) GENDER
DOB Relationship
Full Name (First, Middle, Last) GENDER
DOB Relationship
Full Name (First, Middle, Last) GENDER
DOB Relationship
Full Name (First, Middle, Last) GENDER
DOB Relationship
Full Name (First, Middle, Last) GENDER
DOB Relationship
Full Name (First, Middle, Last) GENDER
DOB Relationship
Ways to request a non-ling verication from the IRS
ONLINE REQUEST
Available at www.irs.gov
Note: This is typically not available if you have never led taxes before
in prior years. If this is the case, please use the paper request
process detailed below.
TELEPHONE REQUEST
Available from the IRS by calling 1-800-908-9946
Note: This is typically not available if you have never led taxes before
in prior years. If this is the case, please use the paper request
process detailed below.
PAPER REQUEST FORM – IRS Form 4506-T
*Best option for those who have not led taxes in recent years.
Verications will be received within 5-10 days. Processing may
take longer during tax season, but the IRS will still issue non-ling
verications.
Download IRS Form 4506-T at:
https://www.irs.gov/pub/irs-pdf/f4506t.pdf
If you need additional help, please contact the Business Services Desk
at your YMCA location.
click to sign
signature
click to edit
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

FINANCIAL ASSISTANCE YMCA OF GREATER WAUKESHA COUNTY

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 12 May 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document