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It includes accepted verification documents such as tax forms and W-2, paystubs, benefit letters, and outlines annual gross income confirmation, certification, review timing, and office-use award tracking.",{"@graph":14,"@context":77},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/template/","Template",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/template/forms/","Forms",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/template/bedford-area-family-ymca-financial-assistance-application-information-and-verification-form/302239/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/bedford-area-family-ymca-financial-assistance-application-information-and-verification-form/302239.png","ImageObject",442,249,{"name":42,"@type":43},"Aran","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-09-26","2026-09-19",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",6,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69,73],{"name":60,"@type":61,"acceptedAnswer":62},"What are the main requirements to keep financial assistance active?","Question",{"text":63,"@type":64},"Applicants must pay a portion of the fees and use membership benefits at least 8 times per month. If the usage requirement is not met, the membership can be cancelled and a reapplication is required.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"What documentation is required with the application?",{"text":68,"@type":64},"Applicants must provide proof of residence for all household members listed and income verification for all household members who receive income, including dependents not on the membership.",{"name":70,"@type":61,"acceptedAnswer":71},"Which verification documents are accepted for income?",{"text":72,"@type":64},"Accepted documents include 1040 tax form line items (or related tax schedules), W-2, four consecutive paystubs, Social Security/SSI, disability letter, unemployment letter, retirement letter, child support, workers’ compensation, and SNAP or other state/federal benefits.",{"name":74,"@type":61,"acceptedAnswer":75},"How often will my household income be reviewed?",{"text":76,"@type":64},"Household income is reviewed every 6 months from the start date, or at the start of a new program session, and applicants are expected to provide proof of income at those times.","https://schema.org",{"og:url":32,"og:type":79,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":81,"canonical":32},"index,follow",{"doc_id":83,"site_id":7},302239,1790213644,{"code":4,"msg":86,"data":87},"success",[88,93,98,103,108,113,117,122,127],{"id":89,"doc_module":22,"doc_module_name":25,"category_name":90,"show_sort_weight":91,"slug":92},11,"Presentations",90,"presentations",{"id":94,"doc_module":22,"doc_module_name":25,"category_name":95,"show_sort_weight":96,"slug":97},12,"Resumes",80,"resumes",{"id":99,"doc_module":22,"doc_module_name":25,"category_name":100,"show_sort_weight":101,"slug":102},14,"Invoices",70,"invoices",{"id":104,"doc_module":22,"doc_module_name":25,"category_name":105,"show_sort_weight":106,"slug":107},15,"Posters",60,"posters",{"id":109,"doc_module":22,"doc_module_name":25,"category_name":110,"show_sort_weight":111,"slug":112},16,"Social Media",50,"social-media",{"id":114,"doc_module":22,"doc_module_name":25,"category_name":29,"show_sort_weight":115,"slug":116},17,40,"forms",{"id":118,"doc_module":22,"doc_module_name":25,"category_name":119,"show_sort_weight":120,"slug":121},18,"Letters",30,"letters",{"id":123,"doc_module":22,"doc_module_name":25,"category_name":124,"show_sort_weight":125,"slug":126},21,"Paper Templates",5,"papers-templates",{"id":128,"doc_module":22,"doc_module_name":25,"category_name":129,"show_sort_weight":4,"slug":130},158,"General","general-158",{"code":4,"msg":86,"data":132},{"doc_id":83,"user_id":133,"nickname":42,"user_avatar":134,"doc_module":22,"category_id":114,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":26,"language":140,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":12,"update_tm":144,"read_time":22},137455076865,"https://ap-avatar.wpscdn.com/davatar_29158cc5080c5b710cf443261637dec0","Bedford Area Family YMCA Financial Assistance Application  \nIt is the policy of the Bedford Area Family YMCA to provide services within the limits of our resources to anyone who wishes to participate in our programs and understand the benefits of the Y, regardless of his/her ability to pay the standard fees.  \nWe also believe that a strong sense of ownership and pride is developed if the recipient contributes to the cost of his/her YMCA involvement. Therefore, all applicants will be asked to pay a portion of the fees involved. In addition to this, each member will be required to utilize the membership benefits for a minimum of 8 times per month in order to continue receiving subsidy. This includes ALL individuals listed on the membership. If you do not utilize the membership 8 times per month consistently the membership will be cancelled and you will have to reapply for membership and financial assistance. There may be a period of suspension from financial services if you have lost your membership due to nonutilization.  \nName/Head of Household   Address  City   State   Zip   Email   Phone   Cell    \n\n| Membership and/or Program Type (circle applicable membership and/or program) |  |  |  |\n| --- | --- | --- | --- |\n| Youth | Young Adult | Adult | Household |\n|  | Couple | Sports |  |\n\n\n| Household Members at this Residence (Including Self) |  |  |  |\n| --- | --- | --- | --- |\n| Name with middle initial (Last, if different) | Relationship\u003Cbr>(Spouse, Child, etc.) | Date of Birth MM/DD/YY | Check if claimed on Form 1040 as a dependent |\n|  |  |  |  |\n|  |  |  |  |\n|  |  |  |  |\n|  |  |  |  |\n|  |  |  |  |\n|  |  |  |  |\n|  |  |  |  |\n|  |  |  |  |\n\nApplicants need to provide proof of residence for all household members listed above.  \nPlease provide income verification for ALL members of household. If married and filing separately, you MUST also provide spouse’s information. ALL members of the household, including dependents, who receive income must provide documentation, even if they are not on the membership.  \nPLEASE INFORM THE STAFF IF YOUR DOCUMENTATION IS ORIGINAL, WE WILL PHOTOCOPY AND RETURN THE ORIGINALS. WE DO NOT KEEP ORIGINALS AS WE SHRED FINANCIAL INFORMATION WHEN DONE PROCESSING. WE WILL NOT BE RESPONSIBLE FOR YOUR ORIGINAL DOCUMENTATION IF LEFT.  \nANNUAL GROSS INCOME: $   (MUST match verification documents)  \n\n| Required Verification Document (please circle the ones you are providing) |\n| --- |\n| 1040 Tax Form – Line 22 1040 Ez Tax Form – Line 4\u003Cbr>1040a Tax Form – Line 15 Schedule C – Line 7 (If Self-Employed) |\n\n\n| The Following Forms Of Verification aRE Accepted. (Please Circle And Provide Documentation For All Benefits Received) If you received any of these you MUST provide documentation. |\n| --- |\n| W-2 4 Consecutive Paystubs Social Security SSI\u003Cbr>Disability Letter Unemployment Letter Retirement Letter\u003Cbr>Child Support Worker’s Compensation Assistance From Any\u003Cbr>Snap State and/or Federal Benefits Other Source |\n\nIn order to assist as many households as possible we generally offer a maximum of 50% the published rate. Please share any other circumstances that may help us understand your situation.  \n____________________________________________________________________________________  \n____________________________________________________________________________________  \n____________________________________________________________________________________  \n\n| I am requesting assistance from the Y and I certify that all information submitted above is complete and accurate. I understand and acknowledge that as a participant in the YMCA Financial Assistance Program, I will be expected to provide proof of income every 6 months, or at the start of a new program session. If Ido not verify information every 6 months, or at the start of a new program session, as requested, my rate will be subject to increase to the published rate that does not require income verification. If my situation changes, I agree to notify the ","cbCaicSlcEkAzbHn","https://ap.wps.com/l/cbCaicSlcEkAzbHn","pdf",94740,"English","# Bedford Area Family YMCA Financial Assistance Application\n## Policy and participation requirements\n## Household and applicant information\n## Proof of residence and income documentation\n## Accepted verification documents\n## Certification, signatures, and office use","[{\"question\":\"What are the main requirements to keep financial assistance active?\",\"answer\":\"Applicants must pay a portion of the fees and use membership benefits at least 8 times per month. If the usage requirement is not met, the membership can be cancelled and a reapplication is required.\"},{\"question\":\"What documentation is required with the application?\",\"answer\":\"Applicants must provide proof of residence for all household members listed and income verification for all household members who receive income, including dependents not on the membership.\"},{\"question\":\"Which verification documents are accepted for income?\",\"answer\":\"Accepted documents include 1040 tax form line items (or related tax schedules), W-2, four consecutive paystubs, Social Security/SSI, disability letter, unemployment letter, retirement letter, child support, workers’ compensation, and SNAP or other state/federal benefits.\"},{\"question\":\"How often will my household income be reviewed?\",\"answer\":\"Household income is reviewed every 6 months from the start date, or at the start of a new program session, and applicants are expected to provide proof of income at those times.\"}]","Bedford Area Family YMCA Financial Assistance Application - Information and Verification Form | PDF",1789791021]