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Financial Aid Form for Connecticut YMCA Youth and Government

Youth And Government is a not for profit program committed to enabling access to our programs to all interested students. Need-based financial aid is available.
In order to be considered for financial assistance, a student and his/her parent or guardian must fully complete the Application for Financial Aid and submit it to the YMCA Youth And Government.
YMCA Youth And Government has designated contributed funds to insure that those unable to pay the stated fees are able to participate in the wide range of teen programs offered.
1.Student First Name(Required.)
2.Student Last Name(Required.)
3.Your School(Required.)
4.Street Address
5.City
6.Zip Code
7.Contact Phone Number(Required.)
8.Home Phone Number
9.Parent/Guardian First Name(Required.)
10.Parent/Guardian Last Name(Required.)
11.Parent/Guardian E-Mail(Required.)
12.Parent/Guardian Cell Phone Number(Required.)
13.***THE FOLLOWING INFORMATION IS REQUIRED***
**Incomplete Applications WILL NOT be considered for Financial Assistance.**
This amount should come from Federal Form 1040, line 43 OR Federal Form 1040EZ, line 6). Please note: Applications showing an level of over $100,000 will be considered only with extreme hardship circumstances(Required.)
14.Please describe the circumstances which should be considered in making a financial assistance determination. This information is required, regardless of income level.(Required.)
15.Parent Signature: I agree, and it is my intent, to sign this record/document by typing my name in answer to this question and by electronically submitting this record/document to YMCA Youth and Government. I understand that my signing and submitting this record/document in this fashion is the legal equivalent of having placed my handwritten signature on the submitted record/document and this affirmation. I understand and agree that by electronically signing and submitting this record/document in this fashion I am affirming to the truth of the information contained therein and that I agree to all the terms and conditions specified and agreeing to all conditions outlined.(Required.)
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