Y Level (English)

Apply for Y LEVEL MEMBERSHIP financial assistance with this easy online submission form.

Which YMCA of Metro North branch would you like to join?*
Name*

First

Last
Service Area City? Y Level is available to people in our service area only. You must reside in one of the following cities to be eligible for financial assistance. Choose your city:*
Address*

Street Address

ZIP / Postal Code
City: (Choose one. You must reside in our service area)*
Phone*
Email*
Date of Birth for Primary Applicant*

MM slash DD slash YYYY
What membership type are you interested in purchasing?*

Please select one.
Total Number of Adults in Household (including applicant)*
Income Level?*
Income Level?*
Income Level?*
Income Level?*
Income Level?*
Income Level?*
I attest that the above information is accurate and that I live in the service area of the YMCA of Metro North.*
- YES
I understand, the YMCA has the right to audit my financial records and request proof of income at any time. If sufficient documentation is not provided, Y LEVEL awards will be terminated.*
- YES
I understand that I need to purchase a monthly, recurring membership in order to take advantage of the Y LEVEL financial assistance program.*
- YES
I understand that I can purchase a membership online or show my Y LEVEL financial assistance application at the branch Welcome Center.*
- YES
Briefly, please tell us why you chose to reach out to the Y for financial assistance with you membership?*
Please list any additional information that support your request for financial assistance.
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