ATHENS YMCA
915 Hawthorne Avenue
Athens, GA 30606

Financial Assistance Application

 

Please fill out the following information. Membership & Development Director Jacqueline Shirley will reach out to you for additional documents and information on the process.


Adult
Family
Family Health Club
Ladie's Health Club
Men's Health Club
Senior
Senior Couple
Family Information:

Add all family members that live in the household


Job loss
Child suport
Medical bills
Other

After school Program
Summer Camp
Membership
Other (please state)

Yes
No

Under $8,000
$8,001 to $12,000
$12,001 to $15,000
$15,001 to $18,000
$18,001 to $20,000
$20,001 to $25,000
$25,001 to $30,000
Over $30,000

Please itemize your monthly income and expense items

INCOME
EXPENSE

A staff member will contact you for additional documentation. You will be asked to submit verification of the following items (at least 2 out of the 7 items)

  • Special Expenses
  • Three most recent payroll stubs including year to date earnings
  • A copy of last year’s income tax form
  • A copy of unemployment income
  • A copy of child support and/or alimony checks
  • Proof of mortgage or rent payments
  • Proof of automobile payments(s) (if applicable) 

 
I certify that the information on this application is true and complete to the best of my knowledge. I understand the verification documents must be submitted or my application cannot be processed.

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