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START YOUR APPLICATION

BEFORE YOU BEGIN: This application requires you to submit multiple documents. Having them ready beforehand will make for an easier application process. 

REQUIRED DOCUMENTS:

1. Tax documents. Most recent federal 1040 or statement of non-filing. W-2s not accepted.

2. Pay stubs. Last 2 pay stubs or letter from employer stating hours worked and pay.

3. Social security benefits. Letter from the social security office or Notice of Decision stating your monthly benefit amount.

4. Unemployment or disability. Notification of eligible benefits from unemployment/disability office.

5. Child support/alimony. Child support order or screenshot of deposit. 

6. Government assistance. (SNAP, housing assistance, etc.) Letter of explanation of your benefits. If you do not have this, it can be found at access.wisconsin.gov.

7. Proof of other income. If you have other additional income, please provide supporting documentation. This can be an invoice, bank statement, screenshot of deposit, etc. 

*Every document that is applicable to you is required. If a document is not applicable to you, do not attach a file.

 

SECTION 1: HOUSEHOLD INFORMATION

Primary Applicant: (All information is required)
What is your preferred method of communication?
Secondary Adult: (All information is required)
Legal Dependents: (18 and under)

SECTION 2: MEMBERSHIP & PROGRAM INFORMATION

Select Membership Type
(Children ages 19-25 who are college students may be included on the family household membership.)
Select Program Categories
(please note program financial assistance will vary based on the program category)

*Persons requesting assistance for Child Care programs are required to apply for the Wisconsin Shares Child Care Subsidy Program first.  More information can be found at: https://dcf.wisconsin.gov/wishares/apply

 

SECTION 3: INCOME VERIFICATION INFORMATION & SUPPORTING DOCUMENTATION

All documentation must be completed to submit your application.  Make sure to write in your monthly income amounts in the columns below. If a section does not apply to you, write $0. 

We understand that numbers don't show everything.  If there are special circumstances, please include a written explanation below so that consideration may be given.

One file only.
50 MB limit.
Allowed types:  jpg, jpeg, png, gif, pdf, doc, docx, xls, xlsx.
$
One file only.
50 MB limit.
Allowed types:  jpg, jpeg, png, gif, pdf, doc, docx, xls, xlsx.
One file only.
50 MB limit.
Allowed types:  jpg, jpeg, png, gif, pdf, doc, docx, xls, xlsx.
One file only.
50 MB limit.
Allowed types:  jpg, jpeg, png, gif, pdf, doc, docx, xls, xlsx.
$
One file only.
50 MB limit.
Allowed types:  jpg, jpeg, png, gif, pdf, doc, docx, xls, xlsx.
$
One file only.
50 MB limit.
Allowed types:  jpg, jpeg, png, gif, pdf, doc, docx, xls, xlsx.
$
One file only.
50 MB limit.
Allowed types:  jpg, jpeg, png, gif, pdf, doc, docx, xls, xlsx.
$
One file only.
50 MB limit.
Allowed types:  jpg, jpeg, png, gif, pdf, doc, docx, xls, xlsx.
Do you have special circumstances?

I certify that I do not have additional income or assistance not represented above.  I agree, if necessary, to send additional information and documentation to support the above statements.  I understand that assistance is based on need.  In the event that I or my family must cancel our participation, I will contact the YMCA immediately. I understand that if I falsify any of the above information, I will not be eligible for assistance now/or in the future.  Application will be considered incomplete if income is not verified.

Sign above

SECTION 4: CONFIDENTIAL STATISTICAL INFORMATION FOR FUNDING THE FOR ALL PROGRAM

Financial assistance is made possible through the generosity of the Oshkosh Area United Way, Y members & staff, and community donors. Required to apply for United Way funding, the Y must supply statistical data showing our funding is being allocated as intended.  Please fill out the following information so that we can provide accurate data on your behalf.

This information is shared only with the Oshkosh United Way in statistical form. Your family's privacy is always maintained. No names, addresses, or phone numbers are provided to any other agency or business. 

Annual household income:
My family participates in the Free and Reduced School Lunch Program:
List of all family members: (Including Primary Applicant)
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