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YMCA OF WESTERN NORTH CAROLINA
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Main navigation
Home
Virtual YMCA
Programs
Health & Fitness
Find a Program
Active Older Adults
Coaching Connection
Community Health
Group Exercise Classes
Group Training
Health Coaching
LIVESTRONG at the YMCA
Parkinson's Support
Personal Training
Schedules
Sports
Westridge CrossFit
Children & Teens
Afterschool
Center Childcare
Middle School Programs
Sports
Time Out for Parents
Sign Up
The Y Teen Career Club
Swimming
BCS Aquatics Center
Lifeguard Certification
Patton Pool
Piranhas Swim Team
Safety Around Water
Specialty Training
Swim Lessons
Find a Class
Camps
Half-Day Camps
Overnight Camp
School's Out Camps
Summer Day Camps
Find a Day Camp
Community
Diabetes Programs
Diversity and Inclusion
Falls Prevention
Financial Assistance
Food Programs
Volunteer
Schedules
Locations
About
About the Y
Contact
GIVE
Impact
News
Events
Safety Guide
Membership
Status message
The YMCA of Western North Carolina is committed to helping people reach their full potential through programs that build healthy spirit, mind, and body. We serve people of all ages, backgrounds, abilities, and incomes. It is our belief that no one should be turned away for their inability to pay.
Our Y-Access program offers sliding-scale fees designed to fit individual financial situations. Funding is made possible through generous donations to our Annual Campaign.
Please complete the form below. A representative from our business office will contact you regarding your submission. If you have any questions, please call 828 251 5910 or send an email to
ybc@ymcawnc.org
. Thank you.
First Name
Last Name
Primary Phone
Primary Email
Birthdate
Residence
Address
Address 2
City/Town
State/Province
- Select -
Alabama
Alaska
American Samoa
Arizona
Arkansas
Armed Forces (Canada, Europe, Africa, or Middle East
Armed Forces Americas
Armed Forces Pacific
California
Colorado
Connecticut
Delaware
District of Columbia
Federate States of Micronesia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Marshall Islands
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Palau
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
ZIP/Postal Code
Are you new to Y-Access or is this a renewal?
New
Renewal
I am requesting funds for myself.
- Select -
Yes
No
Status message
I am requesting funds for the following individuals in my household (if applicable):
First Name
Last Name
Birthdate
Gender
- None -
Female
Male
Unspecified
First Name
Last Name
Birthdate
Gender
- None -
Female
Male
Unspecified
First Name
Last Name
Birthdate
Gender
- None -
Female
Male
Unspecified
First Name
Last Name
Birthdate
Gender
- None -
Female
Male
Unspecified
Best Day/Time to Call
Please select which program(s) you are requesting funds for at this time
Sports
Aquatics & Swim Lessons
Piranhas Swim Team
Wellness & Fitness
Community Health Classes
Total Household Members
Number of adults/kids living in residence
Status message
This application will not be processed without listing and providing verification of all household income.
Write the gross amount (before taxes) you receive per month for each source below. Check that proof is attached.
Wages and Tips
Unemployment (if applicable)
Social Security/Disability (if applicable)
Food Stamps/WIC (if applicable)
Child/Spousal Support (if applicable)
Worker's Compensation (if applicable)
Rental/Utility Assistance (if applicable)
Other (if applicable)
Loans, Grants, Gifts, etc.
Income Source 1
One file only.
2 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.
Income Source 2
One file only.
2 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.
Income Source 3
One file only.
2 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.
Do you receive "in-kind support" such as a family member or friend paying for expenses? If so, please explain.
How much can you afford to pay for your program?
Tell us more about your situation and how the Y can help.
Honesty Agreement
I certify that the information included in this application is true and complete to the best of my knowledge, and that I do not have additional income not represented on this form. I agree to provide additional information to support this information, if requested. I understand my Y-Access assistance is based on need. In the event that my situation changes, I will contact the YMCA immediately. I understand that if I falsify this information, I will not be eligible for assistance now and/or in the future.