Financial Assistance Consideration Form
Please complete this form if you have used the online calculator and did not qualify for Financial Assistance. 

If you or your family have extenuating circumstances that you would like us to consider in awarding financial assistance—for instance, a job loss or serious illness—please include your information below and a representative will be able to contact you regarding your Financial Assistance application.

Apply as soon as possible. The application must be submitted at least 1 week before the start of the program. 

If you may have any questions, please contact our YMCA of Honolulu Service Center at 808-678-4296 or at info@ymcahonolulu.org. Mahalo.
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Email *
Name *
Phone
 *
YMCA Location you are applying for. Please check all that apply. *
Required
YMCA Program you are applying for. Please check all that apply.  *
Required
Tell us your story. Why are you in need of assistance at this time? *
How will participating in a Y program or membership benefit you /or your family? *
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