915 Hawthorne Avenue
Athens, GA 30606

Financial Assistance Application


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

Please note: Financial assistance for summer day camp is full. We will not process financial assistance applications for membership between May 1st and September 1st.

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

Add all family members that live in the household

Job loss
Child suport
Medical bills

After school Program
Summer Camp
Other (please state)


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 (please enter numbers only)
EXPENSES (please enter numbers only)

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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