Financial Assistance is
available through the
Opportunity Fund
The YMCA of Northern Alberta believes in equality of
opportunity for all members of the communityregardless
of age, race, sex, religion or economic circumstance.
Through the Opportunity Fund, the YMCA membership and
program experience is available to families regardless of
their ability to pay the full fees. Drop in and ask how you can
get started! If you know someone who could benefit from
this program, please let them know.
Every one
deserves
a chance
Opportunity Fund!
AM I ELIGIBLE FOR THE OPPORTUNITY
FUND?
Option 1:
Applicants for the Opportunity Fund are
pre-approved if you are a verified
recipient of:
IS: Income Support.
AISH: Assured Income for the Severely
Handicapped.
ACHB: Alberta Child Health Benefits
(letter with expiry date required).
AAHB: Alberta Adult Health Benefits
(letter with expiry date required).
Option 2:
YES! Eligibility for the Opportunity Fund
is determined by family income and size.
The YMCA uses the Government of Alberta
CORE Income Support Table to help
determine eligibility. The Table identifies a
range of low-income levels from
individuals to 1 or 2 adults with multiple
children. For more information, visit:
http://employment.alberta.ca/AWonline/
IESA/6435.html
You may be eligible to apply for the YMCA
Opportunity Fund if you have unique or
special circumstances and/or are unable
to provide proof of income. If this is your
situation:
1. Stop in and join us for a tour to learn
about all the YMCA has to offerwork-
out areas, schedules and programs for
all ages. At the end of your tour, you will
receive a 3-visit pass to try the YMCA.
2. Complete the Application on the back
of this form and gather the necessary
information.
Please bring in your application and
other requested information, and join
us at one of the drop in times below:
Find out how you can begin your YMCA
membership at a reduced cost.
THE YMCA IS PLEASED TO OFFER THIS
OPPORTUNITY FOR YOU AND YOUR
FAMILY.
 You meet all kinds of
fine people and it gives
you a better outlook.
- YMCA Opportunity Fund Participant

THE OPPORTUNITY FUND

IS MADE POSSIBLE BY
THE YMCA STRONG KIDS
CAMPAIGN.

Option 1:
To be pre-approved please provide one of the following forms of
documentation that is listed on the front of this form.
ALL APPLICANTS:
You will need the following to set up your YMCA Membership:
Photo ID-one adult in the family must have photo ID.
Void cheque, Visa or Mastercard to process your monthly
payments; or banking authorization.
(If you do not have any of these payment methods, please contact your
YMCA for assistance before the appointment).
Option 2:
You must bring the following documents to your appointment:
C urrent paystubs for each adult in the family (minimum 1
month).
Your most recent Income Tax Assessment.
Referral letter from governmental/social service agency.
In addition, please bring documentation regarding all other
sources of income applicable to you:
- Student Finance - Child Support - Child Tax Credit - WCB
*Additional supporting documention may be requested.

Primary Contact Information

NAME: ___________________________________________________ PHONE: ___________________
ADDRESS: ________________________________________________ EMAIL: ____________________
CITY: ____________________________________ PROV: __________ POSTAL CODE: _____________
Please list your name, the name of your spouse and your dependents under the age of 18 who will have a YMCA membership:

FIRST NAME LAST NAME GENDER DATE OF BIRTH (YYYY/MM/DD) INCOME

YES! you qualify for the following options: (please check one) FOR OFFICE USE ONLY

PRE-APPROVED (OPTION 1) APPROVED (OPTION 2)

Membership Contribution $ __________ Program Contribution % __________

# __________ Visit Facility Pass Contribution $ __________ Child Minding Contribution % __________

This application is approved for __________ # of months.

YES, I would be interested in sharing my YMCA story with you.

This approval is valid 30 days from the date on this form. Please forward to your YMCA Centre Business Administrator.

DATE: ____________________ INTERVIEWER: ____________________ SIGNATURE: ____________________

Castle Downs Family YMCA Don Wheaton Family YMCA Jamie Platz Family YMCA William Lutsky Family YMCA
11510 153 Ave 780 476-9622 10211 102 Ave 780 452-9622 7121 178 St 780 481-9622 1975 111 St 780 439-9622