SUPPORT TO GIVE YOU STRENGTH

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1 SUPPORT TO GIVE YOU STRENGTH Annual Campaign Financial Assistance Packet YMCA of Greater St. Louis

2 Financial Assistance at the YMCA of Greater St. Louis Complete attached document and give to your local YMCA Policy Statement: It is the policy of the YMCA of Greater St. Louis to provide services for any person who desires to participate and understands the benefits of the YMCA, regardless of their ability to pay the standard membership or program fees. Those not able to pay the full fee may be awarded assistance based on their demonstrated need. Funds for financial assistance have been made available through generous contributions. Eligibility: 1. Membership or program assistance is evaluated on an individual basis depending upon demonstrated financial need. The family income guidelines developed by the YMCA of Greater St. Louis will determine initial eligibility. Subjective factors such as recent loss of employment, healthcare issues or other extenuating circumstances are also considered with substantiating documentation. If desired, a meeting can be scheduled with your branch s Financial Assistance Designee. All discussions and paperwork are kept confidential. 2. In order to be considered eligible for financial assistance, each applicant must complete the attached assistance form and submit proper documentation. Applications which are not complete will delay the process until all necessary paperwork is submitted. Total supporting income and support must be provided. Falsification or non-disclosure of any item will result in denial of assistance or immediate termination of already awarded assistance. 3. The support for financial assistance comes from contributions through our Annual Campaign. The awards far surpass the funds raised and in an effort to support as many requests as possible, each recipient is asked to pay some portion of the membership or program/activity fees. These payments are in accordance with our guidelines. 4. Eligibility for financial assistance must be renewed on an annual basis (or 6 months for Y-Club or Early Childhood) with new application and supporting documentation. Should your financial situation change during the course of your assistance, one may request a review by writing a letter explaining the situation and providing documentation to verify the change in income or circumstances. 5. The YMCA awards assistance to individuals and households living within our service area. The branch in your service area is the branch financial assistance can be given. Please contact your closest YMCA which services your zip code for information and assistance. 6. If applying for a Household Membership, Household is defined as up to 2 adults living in the same household and their dependents.

3 Note to Applicants: 1. Completed scholarship forms can be delivered to your local branch by mail, in person, of by fax. 2. Total Household income is verified annually and includes wages, subsidies, grants, agency assistance and family support. Please supply copies of documentation from the supporting agencies as well as a copy the most recent years filed tax return, (see attached check list). If Income tax was not filed for the past year, a 1722 letter verifying Non-Verification of Filing Status must be included. If unemployed but not yet receiving payments, include a letter from the state regarding the status of the claim. Non-US citizens must provide a copy of their Visa. 3. If your application is incomplete, you will receive a letter requesting the needed information. Once the additional information is received your application will be reviewed again. Sometimes this review of additional information discloses other information that could be needed and another letter could be sent. Please make sure all information has the name of the person on the application so it can be accurately applied. Once all the data is compiled you will receive an award letter in the mail which will have an expiration date. Please come in and set up your membership or discount as soon as possible. Bring in your award letter, payment for the first month and any joining fees as well as a voided check, debit or credit card to establish your monthly draft. Pre-loaded cards and cards loaded by agencies are not recommended and bounced drafts could cause your membership to be terminated. The best source is your personal checking or savings account. The options for payment are: monthly draft or payment in full for the year. 4. Processing Period: There is a minimum of a 14 day processing period for completed applications, and at high volume times additional days may be needed. Please hold your phone inquiries about status until the 14 days have passed. For those turning in additional information the 14 days starts when all necessary documents are received. Should there be circumstances which cannot be made clear with the submitted paperwork; a personal interview can be arranged. 5. Please submit copies and keep your originals. We can make copies if necessary at the Service Center. 6. Method of Payment: Once all the data is compiled you will receive an award letter in the mail which will have an expiration date. Please come in and set up your membership or discount as soon as possible. Bring in your award letter, payment for the first month and any joining fees as well as a voided check, debit or credit card to establish your monthly draft. Pre-loaded cards and cards loaded by agencies are not recommended and bounced drafts could cause your membership to be terminated. The best source is your personal checking or savings account. The options for payment are: monthly draft or payment in full for the year. Helpful Numbers: Internal Revenue Service (IRS) Internal Revenue Service (IRS) (Letter of Non-Verification Filing) Dept. of Family Services: Social Security Administration: Unemployment Office:

4 Done Item Description Source Financial Assistance Application Both sides completed & readable and signed Service Center or On-line Type of Assistance requested Financial Assistance can apply only one way: Membership; programs; child care; camp Verification Of Household Income Copy of most recent past years tax IRS website or office Adults in the Household, whether Return( we do not need the refund info) they choose to be on the If they did not file then must get a letter Membership or not from IRS verifying their "non-filing" Status Change in income from last year Copies of 2 months most recent pay stubs for all adults current employer W-2's Only if there is a significant change in income & to verify individual income for those filing jointly Copies of all subsidy letters Social Security Local office or received for anyone in the house SSI Disability Local office or Food Stamps Foster Care support Section 8 or any housing support Housing Authority Utility assistance Housing Authority Temporary assistance Unemployment disbursements Unemployment web site Maintenance support Divorce Decree Any other support to anyone in the house Consult their caseworker Other Income Family support Letter from their family with amount Portfolio Statement with disbursements Financial Advisor or investor Pensions Fund manager School Grants School Registrar Inheritance Estate disbursing agent Other Documents that might All pages of the tax return to include IRS need to accompany the application Schedule "C" if self-employed & P & L statement Verification of custody, Child support Copy of Divorce decree or separation Courts or attorney Agreement Still married, not living together Copy of separation agreement, or if none both IRS, Attorney incomes need to be verified by taxes & subsidies Extenuating Circumstances Letter Tell us about the circumstances which Copies of invoices from medical Are unique to your household needs Institutions and impact your financial situation, usually Medical Child Care or Day Camp DFS denial or acceptance for all Children. (If applicable). DFS may only be applied to either child care or camp. Balance of fees not covered by DFS will be the responsibility of the participant to pay. Proof of dependency Tax return should have dependents IRS listed, if not on return, then a birth certificate and a letter from the school Attorney with the parents name, child s name Divorce Decree with dependents names and custodial & tax arrangement Residency verification Mail addressed to the person at the Postal service

5 Confidential Application for Financial Assistance Please complete all questions in full and attach the necessary documents (photocopies only) and return to your branch of the YMCA of Greater St. Louis. Allocation balances must be paid in full or by Electronic Fund Transfer through a bank or credit card account. Please print. Date of Application Name-Primary Address Address Place of Employment City State Zip Work Phone Home Phone Age Birthdate Cell Phone Emergency Contact Name Phone Number Name(s) in Household Age/s School /Employer Birth Date(s) How many adults in the household? Their Ages: Single-parent household? Yes No Application for financial assistance is available for one of the following categories: (Max: 2 adults & Dependent Children) Membership Individual Household Program Childcare* Camp* Other *If this application is for child care/camp, you may be required to obtain a denial of benefits letter from the to continue your application. The YMCA will alert you if this must occur upon their review of all completed information. Have you ever applied for financial assistance at the YMCA? Yes No If yes, which YMCA and when? ITEMIZE INCOME-Monthly Wage, salaries, tips $ School Grants $ Unemployment compensation $ Housing Subsidies $ Social Security compensation $ Utility Subsidies $ Child Support $ Alimony $ State subsidized funding $ Other: TANIF; Family Support etc. $ i.e. Food Stamps, DFS etc. 401K/retirement funds $ Total Monthly Household Income $

6 What dollar amount are you able to pay? MEMBERSHIP $ per month PROGRAM $ per session CHILD CARE $ per month CAMP $ per month What benefits do you see in receiving financial assistance? Why are you applying for financial assistance? What volunteer service can you provide to the YMCA? ***Please explain any extenuating circumstances***** Proof of total household income must be verified at each renewal by furnishing the following: * LATEST COMPLETE FEDERAL TAX RETURN with W 2 s attached (if applicable) * LETTER FROM IRS-NON VERIFICATION FILING LETTER (if taxes were not filed) *Copy of VISA It is the policy of the YMCA of Greater St. Louis to provide services for any person who desires to participate and understands the benefits of the YMCA, regardless of their ability to pay the standard membership or program fees. Those not able to pay the full fee may be awarded assistance based on their demonstrated need. Funds for financial assistance have been made available through generous contributions. The YMCA believes that ownership and pride are best developed when recipients of financial assistance contribute to the cost of their YMCA involvement. Thus, all eligible recipients will be asked to pay a portion of their membership or program fees. DFS recipients will be responsible for full fee balances not covered by DFS. To maintain eligibility of financial assistance the recipient must reapply prior to the expiration date stated on their financial assistance letter. Note: Financial assistance cannot be processed without the income verification. You may be asked to provide additional supporting documentation such as a list of assets and liabilities to evaluate financial need. The YMCA of Greater St. Louis reserves the right to collect outstanding balances prior to considering assistance. Falsification of any information submitted for consideration of financial assistance will result in the immediate annulment of any granted assistance. Applications must be completed in full and are processed in the order they are received. A response will be mailed to you within two weeks of the YMCA receiving the application. Upon completing this application and signing it, I certify that the information supplied therein is true, accurate and complete to the best of my knowledge and have read, understand and agree with the YMCA Financial Assistance policies. APPLICANT S SIGNATURE DATE Appraisal conducted by Date Comments: Amount of assistance granted: Date of Entry to Daxko Staff Initials Mail list code attached?

7 1. Why are you applying for Financial Assistance? 2. How will the YMCA and Financial Assistance benefit you and your family? 3. Are there any unique circumstances that impact your financial stance? APPLICANT S SIGNATURE DATE YMCA STAFF USE ONLY Appraisal conducted by Date Comments Amount of assistance granted? Date of entry to Daxko Staff initials

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