Thanks to generous donors, we are able to fulfill our mission by providing financial assistance for membership, programs, and child care. We are committed to serve all people regardless of income level, but expect participants to contribute something towards the membership or services they receive.

There are three options to apply for financial assistance:

  1. Bring your most recent tax return(within the last 12 months) to the Y and get approval instantly.
  2. Fill out the financial assistance application and provide documentation for everyone in the household of all income sources.
  3. Have another agency who has already verified your household income complete our verification form and send it to us. Some agencies already have this form but any agency can contact us to request the verification form, fill it out, and send it back to us.

You can also use this webform below to apply for assistance online. Be sure to have documentation you can upload electronically to verify your most recent tax return or sources of income.

Please enter the first name of the primary household adult in this field.
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The primary household adult is the adult living in the household who will be the main contact for any membership, programs, child care, or financial assistance at the Y.
Please enter the last name of the primary household adult in this field.
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The primary household adult is the adult living in the household who will be the main contact for any membership, programs, child care, or financial assistance at the Y.
Please enter the primary household adult's date of birth in this field.
Gender
Please enter the gender of the primary household adult.
Phone
Household Residents
Name Age Weight
Please add the names and ages of everyone living in the household.
Type of Assistance You're Requesting (Check all that apply)
Check this box if you're applying for income-based membership assistance.
Check this box if you're applying for income-based program assistance.
Check this box if you're applying for income-based child care assistance.
Household Income Verification
Have you filed for a tax return in the last 12 months?
Would you prefer to verify your income without a tax return?
Please note:
Without uploading a tax return, you must provide all income for all members of the household and upload verifying documents for each income source.
Pleae upload your most recent tax return from within the last 12 months.
One file only.
50 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods.
Aid to Families for Dependent Children
What is AFDC
Aid to Families with Dependent Children (AFDC) was established by the Social Security Act of 1935 as a grant program to enable states to provide cash welfare payments for needy children who had been deprived of parental support or care because their father or mother was absent from the home, incapacitated, deceased, or unemployed.
Please upload documentation that verifies the dollar value of assistance that you are provided.
One file only.
50 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods.
SNAP Food Benefits
What is SNAP
The Supplemental Nutrition Assistance Program (SNAP) is a federal nutrition program. Known previously as "food stamps," SNAP benefits can help you stretch your food budget if you have a low income.
Please upload documentation that verifies the amount of SNAP benefits you recieve each month.
One file only.
50 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods.
Social Security Benefits
What are Social Security Benefits?
The Supplemental Security Income (SSI) program provides support to disabled adults and children who have limited income and resources, as well as people age 65 and older who are not disabled but have limited income and resources.
Veterans or Retirement Benefits
What are Veteran's or Retirement Benefits?
Veteran's benefits could include disability compensation, pension, and housing assistance. Retirement benefits would include any payments being paid to you from a retirement account.
Please upload documentation verifying the amount of veteran's or retirement benefits received monthly.
One file only.
50 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods.
Child Support
What is Child Support?
In family law and public policy, child support (or child maintenance) is an ongoing, periodic payment made by a parent for the financial benefit of a child (or parent, caregiver, guardian, or state) following the end of a marriage or other relationship.
Please upload documentation verifying the amount of child support received each month.
One file only.
50 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods.
Spousal Support
What is spousal support?
When a married couple gets a divorce, the court may award "alimony" or spousal support to one of the former spouses, based either on an agreement between the couple or a decision by the court itself. This is separate from the division of marital property and is decided on a case-by-case basis.
Please provide documentation verifying the amount of spousal support recieved.
One file only.
50 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods.
Employment
More Information on Entering Employment
Please add up and enter the total dollar amount per month from anyone in the household combined. Use the amount that is paid on the check (net amount) not the amount before taxes are taken out (gross amount).
Please upload at least three most recent paystubs for each person in the household who is employed.
Maximum 12 files.
50 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods.
Unemployment Benefits
What are Unemployment Benefits?
Unemployment insurance is a joint federal-state program that provides temporary benefit payments to employees who are out of work through no fault of their own. Please enter the total per month for the entire household.
Please upload documentation verifying the amount of unemployment benefits recieved monthly.
One file only.
50 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods.

What amount do you feel you're able to afford to pay?

Please tell us more about your need for assistance and the benefit you/your family would recieve from such assistance.
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