INFORMATION FOR SCHOLARSHIP ASSISTANCE

Welcome to 92Y Scholarship Services. Please read the following information carefully so we can respond to your request.

  • The enclosed application is for classes and programs registered for with Customer Care. If you are applying for May or Sixty Plus membership, Goldman Center children’s programs (Noar, camps, or nursery school), please call Scholarship Services, 212.415.5699, for the appropriate application.
  • Applications are due at least three weeks before the program start date so we have time to review and respond. Please allow extra time if you are applying during a holiday period.
  • Complete both sides of the application even if you received assistance in the past.
  • Please attach copies of all financial documents to your form. All applications should include a rent or mortgage receipt as well as the other income information described on the application form. If you are submitting more than one application, one set of documents is fine. We do not need social security or account numbers so please cross them out.
  • Program information can be found in 92Y catalogs available in the Main Lobby or on our web site
  • Applications should be returned in person at Customer Care in the main lobby or by mail to the address on the application. Please do not return applications to other 92Y locations or by email or fax.
  • You will be notified about your scholarship by phone or mail. You will then need to complete the registration process and pay the balance of your fees as well as the order processing fees.
  • If you have any questions or concerns, please call Scholarship Services, 212.415.5699 or email, .

All scholarship applications for Summer and Fall 2018 classes and programs must have copies of the following documents (as applicable) attached.

Expenses

  • Rent or mortgage/maintenance statement, receipt, lease or cancelled check
  • If paying tuition and student loans for any family member, a copy of bill and/or scholarship statement

Income

  • Current 2018 pay stub with deduction information.
  • 2017 Federal Tax Return (first two pages) with all schedules, W-2, and 1099 forms.
  • Social Security, Disability, Public Assistance, or Pension notification letter or other documentation if applicable
  • Unemployment Verification and most recent pay stub and tax return


SCHOLARSHIP APPLICATION

Please mail completed applications to:
92Y Scholarship Services
1395 Lexington Avenue
New York, NY 10128
Applications can also be dropped off at
the Box Office in the Main Lobby.
Do not email or fax applications.
For more information, call 212.415.5699.

All applications must include financial documentation.

Applications are due at least three weeks before

the start date of the program requested.

Applicant/Parent Information

Name Birth Date

Address

City, State, Zip

Place of Employment Occupation How Long?

Home Phone Work Phone Cell Phone

E-Mail Address

If request is for a child: Child’s Name Birth Date

Name of School Current Grade

Program Request (Do not use this application for Noar or summer camp programs)

Program Title ______

Day Start Date Time Fee $

Have you participated in this program previously? If so, when

Scholarship Request

Please plan carefully as all scholarships are partial and you will need to pay the balance of all program fees.

What are you able to pay for this program?

Reason for request

Please provide any additional, relevant information, including unique circumstances

Financial Information

All applications must include a rent receipt or maintenance and mortgage statement, as well as the following documentation of income:

  • 1040/1040EZ or other 2017 Federal Tax Return, with all schedules, 2017 W-2 and 1099’s
  • Current 2018 pay stub
  • Public Assistance verification if applicable
  • Unemployment Insurance verification if applicable and most recent tax return
  • Social Security/SSI Income/ pension verification if applicable
  • School tuition or scholarship statements or student loan statements

INCOME (Attach copies of documentation of your income. We do not need social security or personal account numbers, so feel free to cross them out on your financial documents.)

What is your gross annual income (include all sources and working household members)?

Do you receive child support and/or alimony?

Do you receive financial support from relatives?

Have you received Public Assistance, SNAP Benefits, Unemployment or Disability Benefits during the last year?

Is any household member currently unemployed?

Has any household member been unemployed during the last two years?

EXPENSES (Include receipts, bills, cancelled checks or statements for housing, tuition, and student loans.)

What is your monthly rent or mortgage/maintenance payment?

If you are paying tuition for any family member, what are the fees?

If you have scholarship, what is the amount of the award?

Do you own a car or property other than your primary residence?

Do you have any additional unusually high expenses?

HOUSEHOLD INFORMATION

Household Members:

Name / Relationship / Age / Occupation

APPLICANT/PARENT SIGNATURE DATE

Revised April 2018