Minikani Financial Assistance Request

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YMCA Camp Minikani Financial Assistance Application

We recognize there are times when some families are unable to afford a camp experience for their children. YMCA Camp Minikani has an Annual Campaign fund to provide financial assistance to those in need.

After completing this form, the camp office will contact you within two weeks of applying to confirm your campers eligibility and the amount of assistance your family will be eligible for. Please note that space can be limited in many of our programs, and if you would like to register your camper regardless of the level of assistance you may receive, please register your campers online or call our office at 262-251-9080. Please note that to hold a spot, a deposit is required at time of registration.

To complete this form, at minimum, you will need a copy of the first two pages of your most recent 1040 Federal Tax Form. Other helpful documents may include:

Letter for each child confirming free/reduced lunch eligibility
Supplemental Security Income (Food Stamps or Medicaid) award letter
Public Assistance Benefit Card

How much assistance may be provided?

YMCA Camp Minkani Sliding Fee Scale
Gross Family Income	Total Number in Family
Gross Family Income	2	3	4	5	6	7+
$0 - $15,999	50%	60%	60%	60%	60%	60%
$16,000 - $21,999	40%	50%	60%	60%	60%	60%
$22,000 - $27,999	30%	40%	50%	60%	60%	60%
$28,000 - $32,999	20%	30%	40%	50%	60%	60%
$33,000 - $39,999	10%	20%	30%	40%	50%	60%
$40,000 - $45,999	0%	10%	20%	30%	40%	50%
$46,000 - $51,999	0%	0%	10%	20%	30%	40%
$52,000 - $59,999	0%	0%	0%	10%	20%	30%

Note: Percentages indicate typical amount of financial assistance given off of the cost of the session. No other discounts may be applied towards the fee. Extenuating circumstances may result in a higher or lower level of assistance.

Parent/Guardian Information & Household Information

Parent Name*

First Name*

Last Name*

Phone Number*

Phone Number Type*

Home Cell Work

Email*

Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Total number of people in the family*

Please include all members of the family that live at the above address

Number of Campers Attending YMCA Camp Minikani*

1 2 3 4 5

My Camper(s):*

Are already registered for camp and I am requesting assistance. Are not registered, but I would like to get them registered/on the waitlist regardless of the outcome of this application. I understand a deposit will be collected. Are not registered, and registration will be dependent on the outcome of this application.

Camper 1 Information

Camper 1 Name*

First Name*

Last Name*

Camper 1 Birthdate*

https://ymcaofmetropolitanmilwaukee.formstack.com/forms/images/2/calendar.png

Month

Day

Year

Camper 1 Gender*

Male Female

Other: Other Value

School Type*

Public School Private School Public Charter School Private Charter School

Other: Other Value

Camper 1 School Name*

Camper 1 School City*

Camper 1 has attended Minikani before:*

Yes No

Camper 1 ethnicity*

American Indian or Alaska Native Asian Black or African American Hispanic or Latino Native Hawaiian or Other Pacific Islander White Other

Camper 2 Information

Camper 2 Name*

First Name*

Last Name*

Camper 2 Birthdate*

https://ymcaofmetropolitanmilwaukee.formstack.com/forms/images/2/calendar.png

Month

Day

Year

Camper 2 Gender*

Male Female

Other: Other Value

Camper 1 School Type*

Public School Private School Public Charter School Private Charter School

Other: Other Value

Camper 2 School Name*

Camper 2 School City*

Camper 2 has attended Minikani before:*

Yes No

Camper 2 ethnicity*

American Indian or Alaska Native Asian Black or African American Hispanic or Latino Native Hawaiian or Other Pacific Islander White Other

Camper 3 Information

Camper 3 Name*

First Name*

Last Name*

Camper 3 Birthdate*

https://ymcaofmetropolitanmilwaukee.formstack.com/forms/images/2/calendar.png

Month

Day

Year

Camper 3 Gender*

Male Female

Other: Other Value

Camper 3 School Type*

Public School Private School Public Charter School Private Charter School

Other: Other Value

Camper 3 School Name*

Camper 3 School City*

Camper 3 has attended Minikani before:*

Yes No

Camper 3 ethnicity*

American Indian or Alaska Native Asian Black or African American Hispanic or Latino Native Hawaiian or Other Pacific Islander White Other

Camper 4 Information

Camper 4 Name*

First Name*

Last Name*

Camper 4 Birthdate*

https://ymcaofmetropolitanmilwaukee.formstack.com/forms/images/2/calendar.png

Month

Day

Year

Camper 4 Gender*

Male Female

Other: Other Value

Camper 4 School Type*

Public School Private School Public Charter School Private Charter School

Other: Other Value

Camper 4 School Name*

Camper 4 School City*

Camper 4 has attended Minikani before:*

Yes No

Camper 4 ethnicity*

American Indian or Alaska Native Asian Black or African American Hispanic or Latino Native Hawaiian or Other Pacific Islander White Other

Camper 5 Information

Camper 5 Name*

First Name*

Last Name*

Camper 5 Birthdate*

https://ymcaofmetropolitanmilwaukee.formstack.com/forms/images/2/calendar.png

Month

Day

Year

Camper 5 Gender*

Male Female

Other: Other Value

Camper 5 School Type*

Public School Private School Public Charter School Private Charter School

Other: Other Value

Camper 5 School Name*

Camper 5 School City*

Camper 5 has attended Minikani before:*

Yes No

Camper 5 ethnicity*

American Indian or Alaska Native Asian Black or African American Hispanic or Latino Native Hawaiian or Other Pacific Islander White Other

Supporting Documents

We realize that financial information is not the only indication of need. Please feel free to let us know of any extenuating circumstances your family may be facing. Also take a moment and upload documents that will help us determine the amount of aid we will be able to give you. At minimum, we require a copy of your latest 1040 tax form. We also ask that if your camper is eligible for free/reduced lunch this school year, that you upload a copy of the eligibility letter for each camper.

Describe Reason for Request and any extenuating circumstances your family may be facing. Characters remaining:

100000/100000

Please check all that apply:*

We have a Public Assistance Benefit Card We receive Supplemental Security Income (Food Stamps or Medicaid) My child qualifies for free/reduced lunch None of the above apply to us

Please upload any supporting documentation that you can:

1040 tax forms, pages 1 and 2 (required)
Letter(s) confirming free/reduced lunch eligibility
Supplemental Security Income (Food Stamps or Medicaid) award letter
Public Assistance Benefit Card

Page 1 of your most recent taxes*

No File Chosen