YMCA Camp Benson Scholarship Application

  • 1. Application Information

    A scholarship reduces membership fees, it does not eliminate them. Most scholarships will be granted for 12 months. We request that individuals and families reapply annually with updated documents. Membership fees are subject to change when you reapply. If you do not reapply, your membership will expire.
  • Date Format: MM slash DD slash YYYY
  • 2. All Persons Living In This Household

  • 3. Who Are You Applying For?

  • * Adult Plus includes 1 adult & dependent children OR 2 adults living in the same house. ** Household includes 2 adults & dependent children living in the same house. *** Additional adults added to a membership will be $20/month and may be eligible for a scholarship discount.
  • 4. Qualifications for Scholarship

    Provide all applicable financial documents to the Sterling-Rock Falls Family YMCA Member Services Desk.
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  • • Rent Assistance
    • Food Stamps
    • Birth Certificates/Guardianship Papers (Only for children NOT on taxes)
    • Two Current Pay Stubs (For all adults in the household)
    • Unemployment (For all adults in the household)
    • Court Ordered Child Support or Alimony
    • Social Security or Disability (For all adults in the household)
    • Transcripts for Full Time Students (Ages18-23)
    • If you have no proof of income, you must provide a letter from the person supporting you and a referral letter from someone not related to you (school, clergy, caseworker, etc.)

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  • THIS APPLICATION MUST BE RENEWED EVERY 12 MONTHS. I certify that the above information is true and complete to the best of my knowledge, and that I do not have additional income not represented above. I agree, if necessary, to send additional information and documentation to support the above statements. I understand that sponsorship assistance is based on need. In the event that I or my children must cancel our participation, I will contact the YMCA immediately so sponsorship can be provided to others. I understand that if I falsify any of the above information, I will not be eligible for assistance now and/or in the future.
  • 5. Tell Us More

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