Delaware Ymca Need - Based Financial Aid Application
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1
2FIRST NAME:
NEED-BASED FINANCIAL AID APPLICATION
_____________________________________________
LAST NAME:
DUE TO STATE DIRECTOR BY 2/7/16
_____________________________________________
THIS FORM MUST BE TYPED OR PRINTED
NEATLY IN BLACK INK.
ADDRESS:
_____________________________________________
TO BE CONSIDERED FOR AID, ALL PARTS
CITY: _____________ State: _____ ZIP: __________
OF APPLICATION MUST BE FULLY
COMPLETED
AMOUNT REQUESTED: ____________ (Max$230)
This application is being submitted for consideration for need-based financial assistance towards a
portion of the expenses of the Delaware YMCA Youth in Government Program. Awards will be made by
the Financial Aid. Notifications will be mailed the week of Feb 15th. The Committee reads this application.
****FAMILY INFORMATION****
Number and Ages of Siblings? ______________________ How many siblings enrolled this year in YIG? ______________
Father’s Occupation _________________________________
Mother’s Occupation ___________________________________________
Father’s Annual Income
______________
Mother’s Annual Income
_______
Are there special family circumstances affecting your financial ability to participate in the program?
Serious Illness or Disability _______________
Unemployment_________________
Public Assistance__________________
Single Parent Household________________________
Other________________________________________
**** DELAGATE INFORMATION****
# OF YIG CONFERENCES ATTENDED (circle) 0
1
2
3
4
5
6
7
DOB : _____________
Current Grade:________________ School:_____________________ Delegation: __________________________
Is student currently employed? Yes or No
Summer Employment? Yes or No
Employer ___________________________________
Type of Job______________________________ Hours/Week_______________
School Activities (Clubs, Sports, etc.) _______________________________________________________________________________________
_______________________________________________________________________________________________________________________________________
Hobbies:____________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________________
Volunteer Experience:___________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________________
Leadership Experience:__________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________________
All Financial Aid Forms MUST include the Applicant’s Statement of Need found on the next
page.
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