Childcare Financial Assistance Application

Applicants for YMCA childcare financial assistance must first apply for the subsidy/voucher program through the Buncombe or McDowell County Child Care Services Subsidy Unit, if applicable (licensed programs only). Applicants must also be working a minimum of 30 hours per week or be a full-time student.

Ayuda Financiera de Acceso a la Y

YMCA of Western North Carolina se compromete a ayudar a las personas a alcanzar su potencialidad al máximo a través de programas que desarrollan un espíritu, mente y cuerpo sano. Servimos a personas de todas las edades, habilidades e ingresos. Es nuestra creencia que no se debe negar a nadie nuestros servicios por ser incapaz de pagar. Nuestro programa Y-Access ofrece una escala móvil de pagos diseñados de acomodar a la situación de cualquier individuo o familia. Financiamiento para este programa se hace posible a través del apoyo generoso de nuestros donantes a nuestra campaña anual.

Parent/Guardian First Name

Parent/Guardian Last Name

Primary Phone

Primary Email

Program

Afterschool

Summer day camp

Program Site

Child 1 First Name

Child 1 Age

Child 1 Grade

Child 2 First Name

Child 2 Age

Child 2 Grade

Child 3 First Name

Child 3 Age

Child 3 Grade

Have you applied for county vouchers?

Outcome of phone call and person spoken to:

Number of household members

Monthly income

Annual income

AFCD per month (if applicable)

Food stamps per month (if applicable)

Child support per month (if applicable)

Pensions per month (if applicable)

Other income per month (if applicable)

How many hours per week do you work?

How many hours per week does your spouse/partner work?

Paycheck stub 1

One file only.
128 MB limit.
Allowed types: gif, jpg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip.

Paycheck stub 2

Paycheck stub 3

Tax return

How much could you possibly pay per week?

Are you a single parent?

Are you a full-time student?

Are you a grandparent or older relative with guardianship?

Are you 55 or older?

Please list any extenuating circumstances for us to consider when reviewing your application.

If your child has previously received financial assistance, how do you feel the program has helped your child?

Signature

I acknowledge that if I am offered and accept Financial Assistance, I understand that my portion of the child care program cost must be paid on time and my account must be kept current. Failure to comply with the payment polices outlined in the program handbook may jeopardize future financial assistance.

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