Financial Assistance Application

Your Personal Information
Your Email Address
Your Home Address
May we use email to communicate with you?
Are you currently employed?
Length of time with this employer?
How often are you paid?
Are you currently employed?
Length of time with this employer?
How often are you paid?
List of all dependents living in household
Re-order First Name MI Last Name Birthday M/D/Y Relationship School Attending Weight Operations
more items
Check all that apply
Please check all that apply and provide supporting documentation. Documentation accepted: federal tax form 1040 that shows all dependents, also showing self-employment or IRS letter of non-filing. Use IRS form 4506-T, to receive letter of non-filing and copies of birth certificates. No originals please. Copies can made for you at the front desk of the downtown branch
Upload proof of income here.
One file only.
10 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods.
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