YMCA Pathways Application

For financial assistance with your YMCA membership, please complete our Pathways Application below.
First Name
Last Name
Email
Address
City
State
Zip
Phone
Date of Birth (mm-dd-yyyy)
Gender
 
Race
How many dependents (can only be under 25) are living in your household?
 
How many adults are living in your household?
 
Who is your current employer?

We ask for your current employer because several businesses pay for some or all of their employees' Y membership, and we want to ensure you're getting any benefits that are available to you.
Please tell us your total GROSS monthly household income (please include all household members' incomes).
Please check your YMCA location/area of interest:
 Nir Family YMCA
 Midtown YMCA
 Sampson County YMCA
 Child Care / Camp Programs
 YMCA Camp Kirkwood
 Youth Sports
 Girls on the Run / Stride
 
If you need financial assistance for Afterschool Care, please select the school your child attends. If not, select NA.
Please share any personal circumstances you would like us to consider in reviewing your application. (For example: job loss, medical expenses, family needs, or other challenges.)

In an effort to diligently award scholarships based on need, verification is required. You can help us award you/your family the highest amount of scholarship possible by uploading at least one of the document(s) from the below as verification of your TOTAL household income.
Please select the documents you receive and intend to upload (select all that apply):
 A copy of your most recent tax return (1040 / 1040EZ or 1099) for everyone living in the household or verification of non-filing. This is the preferred verification option. If you do not have a copy of your tax return you may obtain one by calling the Internal Revenue Service at 1-800-829-0922.
 The last 2 paycheck stubs of everyone in the household who is working or a letter from their employer(s) verifying position and wage rate.
 Proof of Social Security or Social Security Disability Income if applicable.
 Proof of any other sources of income if applicable (e.g. Unemployment Compensation / Food Stamps / etc.). Income provided this way will need to include an acceptance letter that is dated no more than 12 months from submission.
 A copy of your FULL-TIME (defined as 12 or more credit hours) school schedule if you are a non-working student.
 I do not have documents to share and would like a YMCA staff member to contact me regarding my request.
 

Note: If you did not file taxes last year, or if you don’t have other documentation required, please submit a letter explaining your personal financial situation. If you are unable to provide verification, you are still encouraged to apply, but may not be awarded scholarship due to lack of verification.
Upload a File:
Renewal Notice & Agreement

Pathways scholarships must be renewed every twelve months. You will be notified 30 days in advance of your renewal date informing you to resubmit your application. If you do not renew your Pathways Scholarship application by your renewal date, the discount will be removed and you will be charged the full rate with no refund.

It is your responsibility to update us with phone numbers, mailing address, email address etc. If you fail to update us, you will still be held responsible for fees incurred with no refund. 

We are committed to serving all people in our community regardless of income. The Y believes a strong sense of ownership and pride are developed when participants contribute to the cost of Y involvement. Therefore, applicants will be asked to pay a portion of their fees. Membership fees are paid annually, semi-annually, or placed on a monthly bank draft. No other payment schedules will be accepted. Program fees will be paid according to the program fee structure. 

I understand that the YMCA of Southeastern North Carolina may ask for income verification at any stage of my membership for auditing purposes.

Incomplete or inconsistent information may lead to delays in processing your application. To ensure timely review, please double-check that all required documents and details are accurate and fully provided before submission.
 By signing, I certify that I have read the above statement and all information is accurate and complete to the best of my knowledge.