Fillable YMCA OF GREATER NEW YORK FINANCIAL ASSISTANCE APPLICATION

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YMCA OF GREATER NEW YORK FINANCIAL ASSISTANCE APPLICATION

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YMCA OF GREATER NEW YORK FINANCIAL ASSISTANCE APPLICATION
Name: Date:
Address:
City, State, Zip:
Preferred Phone #: - -
E-Mail Address:
Financial assistance request for:
Adult Membership Family Membership Senior Membership
Is this application for a new membership or current membership?
New Membership Current Membership
Requested subsidy percentage rate:
5% 10% 15% 20% 25% 30% 35% Other ___ %
For Family Membership and Youth or Child Care programs, list all members in household:
First Name Last Name Relationship
Please share your need for financial assistance.
Applicant’s Signature:
For Office Use Only:
Financial Assistance Granted: %
Award Dates from to
Staff Name:
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YMCA OF GREATER NEW YORK FINANCIAL ASSISTANCE APPLICATION

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Completed 29 October 2020

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