Membership Assistance Application - YMCA of Greater Toronto

ymcagta.org

Membership Assistance Application - YMCA of Greater Toronto

Membership Assistance Application FormFor Staff Use OnlyLAST NAME FIRST NAME DATE OF BIRTH AGE GENDER CATEGORY ASSISTED FEE ADJUSTMENTMission:The YMCA of Greater Toronto is a charity offeringopportunities for personal growth, communityinvolvement and leadership.Address: ______________________________________________________________________________________________________________________City: ___________________________________________________________________________________________________________________________________________________Postal code: _______________________________________________________________________________________________________________Home phone: ___________________________________________________________________________________________________________Business phone: ______________________________________________________________________________________________________E-mail: __________________________________________________________________________________________________________________________TOTALMONTHLY INCOMENotice of assessment $-OR-Monthly household income $Further family income $YMCA Staff ReviewVision:The YMCA of Greater Toronto will focus onmaking connections: connecting people,connecting with youth, and connecting with thecommunity.Values:Caring • Health • Honesty • InclusivenessRespect • ResponsibilityOpening DoorsYMCAMembershipAssistanceEmergency contact & phone number: __________________________________________________________Employment insurance / social assistance $Reason for applying for financial assistance: ______________________________________________Child tax credit / pensions $_________________________________________________________________________________________________________________________________________Alimony / child support $________________________________________________________________________________________________________________________________________Other $I verify this information to be accurate and accept responsibility for notifying theYMCA should my financial situation change.Signature of applicant ________________________________________________________________________________________________________Date _____________________________________________________________TOTAL MONTHLY INCOME (A) $MONTHLY BASIC EXPENSESHousing (rent or mortgage) $YMCA privacy statementThe YMCA of Greater Toronto is committed to protecting personal information by followingresponsible information handling practices. We collect and use personal data in order tobetter meet your service needs, to ensure a safe environment while members are visitingour centres, for statistical purposes, to inform you about the YMCA program or service inwhich you are registered, to complete payment transactions and to satisfy regulatoryobligations. You may also hear from us periodically about other YMCA programs, servicesand opportunities that may interest and benefit you. Visit our website atwww.ymcatoronto.org for more information on our YMCA privacy statement.Property tax $Groceries (estimated monthly food) $Child care $Transportation (gas, insurance, bus fare, etc.) $Utilities – Gas $Joined date:For Staff Use OnlyHydro $Water $1-866-266-YMCAwww.ymcagta.orgFamily head membership #: __________________________________________________________________________________Phone $Date approved ___________________________________________________________________________________________________________Cable $Staff approved ____________________________________________________________________________________________________________Other (student loan, medical bills) $Staff initial _________________________Approved by ______________________ Date: _______________TOTAL MONTHLY EXPENSES (B) $DISPOSABLE INCOME (A) - (B) $Your YMCA’s charitable registration number is: 11930 7080 RR0001


YMCA Membership AssistanceThe YMCA strives to include all members of thecommunity. Through the YMCA Strong Kids Campaign,individuals and families can apply for financialassistance in order to participate in YMCA programsand services they otherwise could not afford. Ourbelief as a charity is that no one should be deniedaccess to any YMCA program or service based on theirfinancial circumstances.How is the Membership AssistanceProgram Funded?YMCA Membership Assistance is funded by acombination of sources including the YMCA StrongKids Campaign. Donations made to the YMCA StrongKids Campaign are used directly in the community inwhich they were donated.Applying for Membership AssistanceAnyone interested in applying for MembershipAssistance can be interviewed on the spot at any localYMCA centre. To apply, complete the MembershipAssistance application form on the back of thisbrochure. Once complete, bring in the form along withdocumentation of your income, proof of your expenses(please see list on next page) and a void cheque orcredit card. Your interview will be an in-personassessment of your financial situation and will becompletely confidential. It will take approximately 30minutes for an interview, a tour and membership signupor renewal. YMCA membership terms andconditions apply and you will receive a copy for yourrecords when signing up for or renewing a YMCAmembership.Preparing for Your MembershipAssistance AppointmentPlease be prepared to discuss which YMCA programsinterest you. Review the fee brochure, MembershipAssistance application and program schedule ahead oftime.Once you have filled out the MembershipAssistance form, please bring in copies ofthe following documents that applyto you:Documentation of income:• Bank balances• Two current consecutive pay stubs• Social assistance statement• Child tax benefit slip – supplementalincome for children under six• Employment insurance statement• GST rebatesProof of expenses:• Utility bills (gas, hydro, water, electricity)• Lease/rent /mortgage agreementpayment receipts• Property tax receipt• Transportation bill (insurance, car payment,bus fare, gas)• Cable bill• Phone bill• Internet bill• Child care receipt• Other fixed expensesActivating Your MembershipPlease have a void cheque or credit card available atyour appointment should your assistance applicationbe approved. All applicants who have been approvedfor membership assistance have four weeks to activatetheir membership.Most Commonly Asked QuestionsWho is eligible for the YMCA MembershipAssistance Program?People whose financial circumstances make themunable to pay the full fee for a General membership.Can my whole family apply for a YMCAMembership?Yes. Ask a YMCA staff person about familymembership requirements.If I receive YMCA Membership Assistance,what is expected of me?ConfidentialityAll information you provide will be kept confidential.We also ask that you keep the content of ourinterview confidential.CommitmentA YMCA Membership requires a commitment tomaking your payments on time and to using yourmembership regularly. (Recommended minimum use:once a week.)CommunicationIf your financial situation changes and/or you nolonger require assistance, please speak to aMembership Representative. This enables the YMCAto help other individuals and families who areunable to pay the full fee.• Void cheque or credit cardHow much financial assistance will beprovided?Everyone must pay a portion of the monthly fee.Some are able to pay more while others pay less.We assess everyone individually and ask you tobring your financial records to your interview. Wewill discuss all of your options during your interview.

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