Rome YMCA Financial Assistance Application

The Rome YMCA provides assistance every year to hundreds of families in our community. The YMCA is a non-profit organization, and a significant part of our mission is to make membership and programs affordable for everyone. Please complete this financial aid application to see if you qualify for financial assistance – we are here to help support your desire to live a healthier life! 

Once your Application for Financial Assistance is submitted, you will receive a confirmation email from the Rome YMCA. Please print your email and bring it to the Rome YMCA along with proof of income (current Federal Income Tax Return/public assistance documentation, etc.) Applications cannot be processed unless supporting documentation is provided to the Rome YMCA. 

For questions regarding this application or Financial Assistance at the Rome YMCA, please contact our Membership Director, Jeff Sinnock at

First Name
Last Name
Home Address
City, State & Zip Code (no commas)
Spouse's Full Name
Application For: (Check all that apply)
 Membership  Program (Basketball Swim Etc.)  Day Camp
If applying for Program or Camp assistance, please list participant name(s).
How many children do you have?
Have you received financial assistance from the Rome YMCA in the past?

Monthly Income Information

Please fill in your monthly income as accurately as possible into the calculator below. 

Use numbers only. No dollar signs ($), periods (.), commas (,) or letters. Thank you.
Number of Family Members
Monthly Wages, Salaries, Tips for you (before taxes)
Monthly Wages, Salaries, Tips for your Spouse (before taxes)
Monthly Unemployment compensation you receive
Monthly Social Security compensation you receive
Monthly Child Support you receive
Other monthly income you receive
(e.g. Food Stamps, Aid to Dependent Child, 401K, Alimony, etc).

Additional Information

Please inform us of any special circumstance that affects your income examples; recent unemployment, medical bills etc.

In order to calculate your potential discount correctly, please ensure you used numbers only. No dollar signs ($), periods (.), commas (,) or letters. Thank you.

Monthly Income
Annual Income
Membership Discount (%)
Program/Camp Discount (%)