YMCA Camp Piomingo Financial Assistance Application Thank you for your interest in YMCA Camp Piomingo s Financial Assistance program. Attached you will find the required application. There are several documents and forms that must be returned with the application in order for your request to be processed. Please read and complete the application thoroughly to ensure each item is completed. Any missing information may result in a reduction, delay, or denial of financial assistance. It is the goal of the YMCA of Greater Louisville to turn no one away because of inability to pay. Contributions raised through the Annual Campaign help to provide financial assistance on a sliding scale and to keep our program fees affordable. All financial assistance is granted on a sliding scale based on income and need. Please be aware that YMCA Camp Piomingo does not provide 100% scholarships. All applicants will be required to pay a portion of the camp fees. Please Note: The deadline for applying for financial assistance for your camper to attend YMCA Camp Piomingo 2018 is Friday, April 27 th, 2018. To process your application all of the following information is required. If you do not file taxes or do not have one of the required documents, you may submit a letter explaining your personal financial situation. Application Check list: o Completed YMCA Camp Piomingo Financial Assistance Application (pg. 2 and 3) o Completed Summer Camp Registration Form for each camper (pg.5) o A copy of the first page of the tax form from your most recent tax return. o If you do not have a copy of your tax return, you can obtain one by calling the Internal Revenue Service. The information must include adjusted gross income and a list of dependents. Please black out social security numbers. o Proof of income for EACH adult in the household. o This includes copies of the last two pay stubs and proof of all other income that comes into the household (ie. social security checks, disability checks, unemployment, SNAP benefits etc.) o For foster children please provide a copy of stipend from DSS and other related documents. Please Note *Financial Assistance may only be applied to two weeks per camper. This means the camper may use their financial assistance award towards two 1 week session or one 2 week session. Financial assistance will be applied upon registration and cannot be applied to registrations that occur later in the summer. *Please allow 5-7 business days to process your application once you have submitted a completed application and all required documentation. *Additional documentation may be requested 1
YMCA Camp Piomingo Financial Assistance Application This application is not to be considered a guarantee of financial assistance. We are unable to tell you what percentage of camper fees you will be required to pay until your application has been processed. Incomplete applications will not be considered. It is your responsibility to ensure all necessary documentation is submitted by the deadline (April 27 th, 2018). Please print or type the information requested below. Please use the letters N/A to indicate when information requested does not apply to you. Adult Applicant s Information (parent or guardian, please print) First Name: Middle Name: Last Name: Birthdate: *Email: Home address: City: State: Zip: Primary Phone: Cell/Other Phone: Business Phone: Employer: Second Adult in Household (please print) First Name: Middle Name: Last Name: Birthdate: Email: Home address: City: State: Zip: Primary Phone: Cell/Other Phone: Business Phone: Employer: *Email address is required, please indicate if you do not have email access. Household Information Please list all dependents or additional adults living in your household (please print). Household Member Name Date of Birth Gender Relationship to person filling out the form Would like to attend camp? Total number of children in household: Do you share expenses with anyone else in your household? Yes No 2
Gross Annual Income and Expenses Please complete the table below indicating how expenses are allotted in your household (please print). Household Income Head of Household 2 nd Adult Household Expense Amount Employment $ $ Mortgage $ Child Support $ $ Electric/Gas/ $ Water Government $ $ Insurance $ Assistance SNAP Benefits $ $ Phone $ Student Loans $ $ Medical Expenses $ Other $ $ Credit Cards $ Total $ $ Auto Loans $ Total $ Has your camper ever applied for financial assistance to attend YMCA Camp Piomingo? Yes No Does your camper currently receive financial assistance through the YMCA s CEP or SAC program at his or her local YMCA branch? Yes No 3
Application Submission Instructions Financial assistance applications may be submitted via email to the Office Manager, Alison at piomingo@ymcacamppiomingo.org. Applications may also be mailed via USPS to: YMCA Camp Piomingo ATT: Office Manager 1950 Otter Creek Park Rd. Brandenburg, KY 40108 Please remember that only completed applications will be considered for assistance. Don t forget to submit the following items: What Happens Next? o Completed Financial Assistance Application (pg. 2 &3) o Completed copy of your income tax return. If you do not file taxes, a signed letter from a government services worker stating your benefits is acceptable o Any additional documents needed to show proof of income o Camper Registration Form (page 5) 1. Wait for acceptance letter from Camp Piomingo. This will be sent via email unless otherwise indicated. You will receive a response once your application has been received. You will receive a copy of your financial assistance award letter within 5-7 business days. 2. Once you have received your award letter, you ll need to return the following within 1 week: o Nonrefundable $100 deposit to reserve your spot (payment plans are available). You may submit a check, cash, or call to make payment over the phone. If we do not have a response back from you within 2 weeks from the day you receive your acceptance letter we will assume that your camper is not interested in attending camp this summer. o Camper thank you letter to sponsors 3. Once your deposit has been processed and your camper thank you card has been received, YMCA Camp Piomingo will email you a welcome packet confirming your registration and will include additional camp information, packing tips and health forms. Note: Please include your email address on the application. Please indicate if you do not have email access or are unable to print the necessary information. If you have any questions or require assistance, please contact Alison, the Office Manager, by calling 502-942-2616 or submitting an email to piomingo@ymcacamppiomingo.org. 4
Camper Registration Form Please complete one section for each camper that would like to attend camp this summer. If the address for subsequent campers is the same as Camper 1, please write same on the address line. Session options are listed on page 6. 1. Camper Name: Age: Date of Birth (mm/dd/yyyy): Gender: Has your child ever attended YMCA Camp Piomingo before? Yes NO 2. Camper Name: Age: Date of Birth (mm/dd/yyyy): Gender: Has your child ever attended YMCA Camp Piomingo before? Yes No 3. Camper Name: Age: Date of Birth (mm/dd/yyyy): Gender: Has your child ever attended YMCA Camp Piomingo before? Yes No 4. Camper Name: Age: Date of Birth (mm/dd/yyyy): Gender: Has your child ever attended YMCA Camp Piomingo before? Yes No (Please see page 6 for session types and dates) 5
Please select a Session Type Program Age Duration/Rate Frontier 6-7 3 Days/3 Nights - $360 Pioneer 8-12 1 week - $630 Explorer 10-13 2 weeks - $1100 Equestrian 10-16 1 week - $710 2 weeks - $1260 CampCrafter 13-15 1 week - $630 2 weeks - $1114 Counselor in Training 16 3 weeks - $1300 Please select your Week Number Weeks/Sessions 1 Week and ½ Week Programs (Frontier, Pioneer, Equestrian 1, CampCrafter1 Sessions) Week 1: June 10 th 16 th (Frontier Session 1: June10 th - 13th) Week 2: June 17 th 23 th Week 3: June 24 th June 30 th (Frontier Session 2: June 24 th -27 th ) Week 4: July 1st 7 th Week 5: July 8 th 14 th (Frontier Sessions 3: July 8 th -11th) Week 6: July 15 th 21st Week 7: July 22 rd 28 th (Frontier Sessions 4: July 22 nd - 25th) Week 8: July 29 th August 4 th 2 Week Programs (Explorer, Equestrian 2, CampCrafter 2) Session 1: June 10 th June 23rd Session 2: June 24 th July 7 th Session 3: July 8 th July21st Session 4: July 22nd August 4 th 6