2019 YWorld Application

  • Date Format: MM slash DD slash YYYY
  • (She/Her/Hers) (He/Him/His) (They/Them/Their) (Other…please provide)
    I would like for my student to apply for the scholarship (payment of $55/$50 per month) (Must provide proof of government assistance to qualify)
    I would like to signup for the auto-pay option to receive a monthly discount of $5
  • Medical Information

  • (Provider, Policy Holder's Name, Policy #)
  • Pick Up

    On occasion, the following people have permission to pick up my child from the YWCA Program
  • Please provide the YWCA Greensboro a copy of any custody, visitation orders, and/or agreements if applicable.