Financial Assistance with Addendums

YMCA Financial Assistance for Programs

Please fill out the below form honestly and accurately. The YMCA reviews each application individually.

We use a sliding fee scale based on total household income and the number of household members. We require supporting documentation to verify household size and income, and we consider special circumstances when providing assistance.

We understand your financial records may not contain the entire picture of your financial needs. Please include any and all information you feel is applicable to your current situation.

Recipients are expected to be responsible for a percentage of the program fees. Qualification for YMCA financial assistance for programs is reviewed every year.

At the end of the form, you will be asked to upload your 2024 federal tax returns.

Important

The YMCA of the Triangle provides financial assistance for people living in our regions including Chatham, Durham, Johnston, Lee, Orange and Wake counties in North Carolina.

Adult Information

First Name

Last Name

Date of Birth

Format mm/dd/yyyy

Gender

Phone

Street Address

Apt. Number

City/Town

State

Zipcode

YMCA

Please select the YMCA closest to you.

Occupation

Length of Employment

Is there a second adult living in the same household?

First Name

Last name

Date of Birth

Gender

Dependent Information

Please list all the dependent children in the household. Tax forms must reflect those who whom you list below.

Child Full Name

Child Date of Birth

Format mm/dd/yyyy

Gender

Grade

Do you need to add another child?

Child Full Name

Date of Birth

Format mm/dd/yyyy

Gender

Grade

Do you need to add another child?

Full Name

Date of Birth

Gender

Grade

Do you need to add another child?

Full Name

Date of Birth

Gender

Grade

Your Story

Please share your reasons for applying for YMCA financial assistance. Please include any and all relevant details about recent life changes or anything you deem important.

For example, a recent separation, job loss, or caring for an elderly parent.

Please Share Your Story

Tax Returns

Please submit your 2024 federal tax returns (Form 1040 pages 1 and 2 only, or 1040 EZ).

If you do not file federal income taxes, please call 1-800-TAX-FORM (1-800-829-1040) for verification of non-filing or visit IRS.gov for additional information.

If you are unemployed, draw social security, or are a full-time student, please provide a summary of your unemployment benefits, SSI paperwork, or financial aid benefits and student schedule.

You may upload up to four files. Please make sure you have marked over personal data information such as social security numbers.

Supporting Files

Only image and PDF files are accepted.
One file only.
10 MB limit.
Allowed types: gif, jpg, png, pdf, .

Agreement

I certify that this information is true and complete to the best of my knowledge. I grant permission to the YMCA to verify this information. I agree to notify the YMCA if my financial status should change.

Program Information

YMCA financial assistance is available for a variety of our programs. Please select the programs you need for your family.

	Select Your Program
25 - 26 After School Programs	25 - 26 After School Programs
25 - 26 Before School Programs	25 - 26 Before School Programs
25 - 26 Track Out Camp	25 - 26 Track Out Camp
Leaders Club	Leaders Club
Y Achievers	Y Achievers
Y Guides	Y Guides
YOTA Swim Team	YOTA Swim Team
YMCA Super Skippers	YMCA Super Skippers
Youth Sports	Youth Sports
Youth Swim Lessons	Youth Swim Lessons

School Name

Please list your child(ren) schools.

School Calendar

Track Number

Medical Expenses Pertaining To Your Child

Y Guides Programs

Delegation Name

Please enter the name of your student's Youth & Government delegation.

Day Camp Names

Please enter the day camp names and locations for your child(ren).

CAPTCHA

Math question (3 + 4 =)

Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.

This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.