null

of 2
7 views
PDF
All materials on our website are shared by users. If you have any questions about copyright issues, please report us to resolve them. We are always happy to assist you.
Document Description
YMCA of Western North Carolina Financial Assistance Application/Screening Form Deadline Date: April 16, 2012 (While the deadline is April 16th, we will continue to review these as long as there is funding available. In the event that our funding is exhausted, we will waitlist eligible applicants in the event that additional funding becomes available.) Summer Camp 2012 Date________________________________ Parent’s _____________________________ Hm # _______________________________ Cell # _______
Document Share
Document Tags
Document Transcript
  YMCA of Western North CarolinaFinancial Assistance Application/Screening Form Deadline Date: April 16, 2012 (While the deadline is April 16th, we will continue to review these as long as there is funding available. In the event that ourfunding is exhausted, we will waitlist eligible applicants in the event that additional funding becomes available.) Summer Camp 2012 Date________________________________  Child’s Name:____________________________    Parent’s _____________________________ Age:____ Sex: ____ Race: ________ Grade:___ Hm # _______________________________  Child’s Name: ____________________________   Cell # ______________________________ Age: ____ Sex: ____ Race: ________ Grade:___  Wk # _______________________________  Child’s Name: ________   ____________________ S/C Site:_____________________________ Age: ____ Sex: ____ Race: ________ Grade:___  As you know, the YMCA is for everyone, and we provide a variety of programs and services for children, adults and families…  Is your child currently in our Afterschool Program? ______ Site: ___________  The YMCA does have limited resources available to provide financial assistance, but it isa requirement that you apply for subsidy first through Buncombe County Child CareServices. Have you applied for county vouchers?________  In order to qualify for financial assistance for child care, parents must meet the program’s guidelines. Parents must be working full-time (30 or more hours perweek) or enrolled in school full-time.How many hours per week doyouwork? _______ yourspouse?______  Are you a single parent? _______ Are you a full time student? ________ If so, attach a copy of your full-timeschool schedule.Have you attached cop   ies of your last three paycheck stubs? _________ Have you attached a copy of your 2011 tax return? (1 st page only) _______ Amount you could possibly pay per week? _________________ Are you aware there is a registration fee of $35.00 (1) $50.00 (2+) ? ______ This amount is not covered by financial assistance.Have you completed the entire Financial Assistance application including the “  Extenuating Circumstances ” forus to consider when reviewing your application? ________ I hereby acknowledge that all of the information provided on this application is true and correct. _______________________________________ __________________ Parent Signature Date   FINANCIAL INFORMATION My total Family Income is:Monthy $   _____________    Annually $   ______________   Do you receive any of the following? If so, how much PER MONTH?  AFCD $   ____________   Food Stamps $   _____________   Child Support $   _____________   Social Security $   _____________   Pensions $   _____________   Other $   ______________     Please list any extenuating circumstances for us to consider when reviewing your application: ____________________________________________________________________________________________  ____________________________________________________________________________________________  ____________________________________________________________________________________________  ____________________________________________________________________________________________  ____________________________________________________________________________________________  ____________________________________________________________________________________________ If your child has previously received Financial Assistance, how do you feel the program has helpedyour child? ____________________________________________________________________________________________  ____________________________________________________________________________________________  ____________________________________________________________________________________________  ____________________________________________________________________________________________    I authorize the YMCA to share my story. Yes No  As a recipient of a YMCA scholarship …  Would you be willing to volunteer during the Annual Fund Raising Campaign?   Yes    No   Would you be willing to volunteer in the Afterschool Program? Yes No If so, in what area would you like to volunteer? Marketing Office/AdministrationGeneral Site SupervisionTeaching Special SkillsOther   ___________________________________________________________    I acknowledge that if I am offered and accept Financial Assistance, I understand that my portion ofthe child care program cost must be paid on time and my account must be kept current. Failure tocomply with the payment polices outlined in the program handbook may jeopardize future financialassistance. Initial ____________  _________________________________ __________________ ________________________ Parent ’s Name Date ________________________  ________________________  Child(ren)’ s Name(s) Office Use Only Previous F.A.________________________________________________________________________________________________________________________________________________
We Need Your Support
Thank you for visiting our website and your interest in our free products and services. We are nonprofit website to share and download documents. To the running of this website, we need your help to support us.

Thanks to everyone for your continued support.

No, Thanks
SAVE OUR EARTH

We need your sign to support Project to invent "SMART AND CONTROLLABLE REFLECTIVE BALLOONS" to cover the Sun and Save Our Earth.

More details...

Sign Now!

We are very appreciated for your Prompt Action!

x