Financial Assistance Application

Please check all that apply and provide supporting documentation. Documentation accepted: federal tax form 1040 that shows all dependents, also showing self-employment or IRS letter of non-filing. Use IRS form 4506-T, to receive letter of non-filing and copies of birth certificates. No originals please. Copies can made for you at the front desk of the downtown branch.

The Legal Stuff

Fee Scale

The Jackson YMCA uses a sliding scale to determine a rate to fit your financial situation. All participants pay something towards their program. You will be contacted by email, phone, or letter with your award. Once this contact has been made you have 30 days to accept the award. To accept the award, you MUST visit the YMCA service desk and SIGN a payment agreement.

Statement of Responsibility

I hereby certify that the information supplied herein is true, accurate and complete to the best of my knowledge. I am also aware that it is my responsibility to notify the Jackson YMCA in writing of any change in information supplied in this application, such as income, address, living arrangements, or other matters which might affect my eligibility for financial assistance. I understand that failure to do so may result in immediate revocation of scholarship privileges.