PLEASE READ THE ENTIRE STATEMENT BELOW BEFORE COMPLETING THE APPLICATION.

YMCA of Barry County programs and services are open to everyone regardless of race, religion, color, age, sex, national origin,
special needs or ability to pay. The YMCA of Barry County will provide financial assistance and/or scholarships, providing the
amount of assistance being offered does not exceed the financial resources of the Association, to any qualified resident of
Barry County, MI unable to afford the program fee. Financial assistance is available on a first come-first serve basis. The level
of assistance is based upon household size and income. Funds to provide financial assistance and scholarships are provided by
the Barry County United Way and the YMCA of Barry Countys annual Partners for Youth campaign.

The YMCA reserves the right to request proof of income. Proof of income must be submitted in order to process your application
for financial aid. Proof of income must be submitted in the following form: previous years tax return for each adult in the household.

1) This form is to be completed by the Applicant - one application per household.
2) Applicant households must be residents of Barry County, MI in order to be considered for financial assistance.
3) If approved, financial aid may be used for any YMCA of Barry County / Camp Algonquin program from April 15
of the current year through April 15 of the following year.
4) Please note that fields marked with an * are required.

Financial Aid Application ~ April 15, 2010 - April 15, 2011


Applicants First & Last Name *

(NOT childs name)
# of Adults in household: *
Applicant's Marital Status


Other Adult


Spouses first & last name or that
of any adult in the household
other than the applicant.


Email


(Only if you would like us to contact
you by email.)
Home Phone *
Cell Phone
Work Phone
Please enter your
mailing address *
City *
Please choose your township.
NOT your county. *
State *
Zip *
Please enter the county
in which you live *


Question 1 *

There is at least one child living in my home, related
by blood, marriage or adoption, who is under the age
of 18
and attending school full time.
# of children (under 18)
in the household *
Child(ren)'s Name(s) & Age(s) *
Applicant's Occupation(s):
Date of Hire for your
current occupation(s)
Applicant's Annual Income:
Occupation(s) of any/all other
Adults living in the household:
Date of hire for spouses or other
adults current occupation(s)
Total Annual Income for all other
adults living in the household:


Question 2

Select the total household annual income range. Income means
the total amount of money you or other household members receive.
Examples are: earnings before deductions, social security benefits,
supplemental security income, any disability benefits, unemployment
benefits, worker compensation, child support, etc. Based on your total
household annual income range, registration fees may be reduced by
the following percentages:
$0 - 20,000...100%
$20,001 - $25,000...70%
$25,001 - $30,000...50%
$30,001 - $35,000...30%
$35,001 - $40,000...10%
Question 3 * At this time our family is seeking a % scholarship.
(Percentages for each income bracket are listed above at the end of question 2.)
Question 4 If the total household annual income does not fall within any of the above
ranges, the percentage of aid requested is greater than the percent listed
next to the household annual income bracket, or a family or financial crisis
is prohibiting your family from participating in YMCA programs, please explain.
Volunteer Description In addition to financial aid could you volunteer your time or talent in some aspect
for the YMCA of Barry County? (Your answer will have no affect on whether or
not you receive financial aid.)
Would you like to volunteer?
If you answered yes above,
in what area would you like
to be considered for
volunteer work?
Please list any experience
you might have in the field
you have chosen above.
IMPORTANT!
Please read before submitting:		 The policy established by the YMCA Board of Directors requires each applicant
to supply proof of income to be considered for financial assistance. Proof of
income must be submitted in order to process your application for financial aid.
Proof of income must be submitted in the following form: previous year’s tax
return for each adult in the household.

Any extenuating circumstances, if included on your application, will be considered
as well. Proof of income can be sent to us via fax, email, through the postal service
or placed in one of our drop boxes. It will be kept in strictest confidence. Please note
your financial aid application along with any registrations that you may have submitted
will be on HOLD until we receive this information from you. We will then contact you
regarding the status of your financial aid application and/or registrations.


I Agree:

By checking this box I agree to the best of my knowledge, the information given
above is accurate and complete
**WARNING** After clicking submit, the next screen will say THANK YOU at the top. If you do not
see that screen your application has not been submitted properly. This may be due
to certain manditory fields left blank. If so, you will see a notice in red under the field(s)
in which information is missing. Fill in any missing information and click submit again.
Thanks.


Send My Form