YMCA of Honolulu Income Verification

Use this form to securely upload your financial documents to qualify for Financial Assistance. The application must be submitted at least 1 week prior to the start of program or membership.
Required Documents:
**Submit required documents for ALL adults living in the household*** -Your Government-issued photo ID -Most recent W-2(s) -Full tax return (1040, 1040EZ, 1040A, or Schedule C) Alternative Documents Accepted (If W-2s or Tax Returns are not available): -Copy of paystubs (one-month) -Benefit Statement (Social Security, Disability or Unemployment) -Government Assistance Benefits letter -Letter from your employer verifying your employment and stating your annual salary -For United States Military members: Leave and Earnings Statement (LES) Once income has been verified, your documents will be deleted in its entirety.
Name Name First Last
Phone Phone - ### - ### ####
Email
Household Size: Adults in the Household
Household Size: Youth/Dependents in the Household
YMCA Location you are applying for. Please check all that apply.

YMCA Location you are applying for. Please check all that apply. Camp H.R. Erdman Kaimuki-Waialae YMCA Kalihi YMCA Leeward YMCA Mililani YMCA Nu'uanu YMCA Windward YMCA
YMCA Program you are applying for. Please check all that apply.

YMCA Program you are applying for. Please check all that apply. Membership Aquatics Early Learning Day Camp (Summer & Intersessions) Culture & Arts/Martial Arts (Dance, Sports, etc.) Before or After School Programs (Excluding Aplus) Pre-Teen/Teen Programs Resident Camp (Camp Erdman)
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I understand that I am providing my financial documentation for the sole purpose of verifying income to qualify for financial subsidy. Once these documents have been reviewed, all information will be deleted in it's entirety. The YMCA of Honolulu will not store this information.
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Financial Assistance is provided by generous donors and volunteers.

Every year, the YMCA of Honolulu raises more than $1 million through our Annual Campaign thanks to the generosity of thousands who want to ensure that the Y is there for those who need us most.
Please tell us why financial assistance would be helpful.
Tell us your story. How will participating in a Y program or membership benefit you and/or your family?
Would you be willing to share your story in an effort to communicate the importance of giving to our Annual Campaign?

Would you be willing to share your story in an effort to communicate the importance of giving to our Annual Campaign? Yes No Prefer not to answer
Would you be willing to convey messages of thanks to donors of our Annual Campaign?

Would you be willing to convey messages of thanks to donors of our Annual Campaign? Yes No Prefer not to answer
Would you be willing to participate in our Annual Campaign by raising funds?

Would you be willing to participate in our Annual Campaign by raising funds? Yes No Prefer not to answer
Notes:

Use this field to add any additional information you would like us to know.

YMCA of Honolulu Income Verification

Financial Assistance is provided by generous donors and volunteers.