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Skagit Valley Family YMCA: Y for All Application

Our goal is to make Y programs as affordable as possible. The amount of financial aid we can provide year-to-year varies and may change based on available resources. Please complete this form in its entirety and attach all appropriate documents. Additional information can be found at www.skagitymca.org/y-for-all/

Legal First Name *

This person will be the primary member on the membership account and is the sole person who can make account changes, including adding or subtracting household members, changing billing information, etc.

Middle Initial *

Legal Last Name *

Your Email *

Phone Number *

Date of Birth *

Mailing Address *

City *

State *

Zip Code *

Are you a current Y member? *

Household Information

Please write down all members of your household that you intend to have on your membership. Please include each person's name, DOB, age, and your relationship to them. We will not process your application if you have incomplete answers. If you’d like to add additional people to your membership beyond those listed on this form, please see the Welcome Center for assistance. If you are applying as an individual, you can leave this section blank.

Full Name, Date of Birth, Age, Relationship

Please provide all four

Full Name, Date of Birth, Age, Relationship

Financial Assistance Information

For which Y service(s) are you seeking financial assistance? * *

Membership & Programs (ex. youth sports, summer camp, swim lessons, etc.)

Childcare (Early Learning Centers, School-Age Programs)*

Have you applied for WCCC subsidies through DCYF? (Childcare Applicants Only)

*For Childcare Only: In order to be considered for a Childcare Y for All discount, you must first apply for Working Connections Childcare (WCCC) subsidies through the Washington State Department of Child, Youth, and Families (DCYF) by contacting the Child Care Subsidy Contact Center at 1-844-626-8687 or online at https://www.washingtonconnection.org/home/.

Yes = Please upload or attach a copy of your approval or denial letter. If you were approved for subsidies, you are ineligible for a Childcare Y for All discount but may still be eligible for a membership discount.

No = Please apply using the contacts above before submitting your Y for All application

DCYF Approval or Denial Letter Upload

Monthly Income

Not sure how to calculate your monthly income? Multiply your hourly wage by the number of hours worked each week. If hours vary week to week use a best estimate of the average number of hours worked. Then multiply by 52 weeks in a year and then divide that amount by 12. Your calculations: $_____/hr x _______ hrs/week x 52 (weeks) = $______ ÷ 12 (months) = $_____ monthly gross income

What is your monthly income? *

Spouse/Partner's Income (if applicable)

Other Household Adult(s) Income (if applicable)

Child support/spousal support (if applicable)

Other Income (if applicable)

Unemployment Income (if applicable)

TANF (Temporary Assistance for Needy Families) (if applicable)

SSI (Supplemental Security Income) (if applicable)

Financial Aid Benefits (if applicable)

Documentation

Please upload or attach the following forms of documentation:
• Two months of recent pay stubs for all adults living in the household, and/or
• The first two pages of last year's federal tax return (Form 1040) for all adults living in the household.

If you did not file federal income taxes, please call 1-800-TAX-FORM (1-800-829-1040) or visit https://www.irs.gov/individuals/gettranscript to get verification of non-filing letters. Make sure you have marked over personal data information such as social security numbers.

If you do not have recent pay stubs or can provide documentation that you didn't file taxes, please provide documentation showing income received from government assistance programs. If you can't provide documentation showing income received from government assistance programs, please attach any materials that help describe your situation.

The Y doesn’t give “full ride” scholarships that cover 100% of fees. All members are expected to pay partial fees, so if you don’t list any income in the blanks or provide documentation, you will not be eligible for a discount.

Documentation Upload *

Documentation Upload

Authorization and Consent

By signing below, I affirm that the information recorded in this document is truthful and accurate to the best of my knowledge, and grant the Skagit Valley Family YMCA permission to duplicate, copy, record and otherwise store information and documentation relating to my household income and all other elements of this document. Furthermore, I understand:

• If I’m missing any required documents or answers, my application may not be processed and I’ll need to reapply,
• I may or may not be awarded financial assistance based on my information provided,
• If awarded a discount, I have 30 days to accept or decline the discount before needing to reapply,
• The Y does not give out “full ride” scholarships that cover 100% of fees,
• If I add people to my membership after receiving a discount, I’ll need to reapply for an updated Y for All discount,
• The Y reserves the right to change or alter my discount when I reapply.

Finally, I give permission to the Y to reach out to me with additional questions.

Please write your full name as acknowledgement of the above authorizations. *