Application Form

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A Y for All Community Members

We believe that finances shouldn’t be a barrier to participate at the Y. To apply for financial assistance, complete the fillable application form (EnglishSpanish, or Burmese). Gather all documents in the following list that apply to your situation:

  • Most recent 30 days of income for all wage earners
  • Government assistance verification
  • Social security documents
  • Other sources of income
  • Proof of unemployment
  • Court orders verifying child support

Bring the documents and application to the Membership Services desk at any Y in Allen, Whitley or Wells county or email your completed form to the branch you are joining. Proof of public assistance alone can expedite your application.

Click the link to email your documents to the appropriate branch: