Get Sliding Scale Application Form

This guide provides comprehensive, step-by-step instructions on how to complete the Sliding Scale Application Form online. By following these instructions, users can easily access and submit the necessary information to seek assistance with fees.

Follow the steps to complete the form accurately and efficiently.

1. Click the ‘Get Form’ button to access the Sliding Scale Application Form and open it in your browser.
2. Fill in your personal details at the top of the form. Provide your name, date, address, city, state, and ZIP code accurately.
3. Enter your contact information, including your home and work phone numbers. This ensures the organization can reach you for any follow-up.
4. Provide your Social Security number and list your current employer. This information is vital for processing your application.
5. In the section labeled 'Those living in home,' list the names of individuals for whom you are legally responsible. This may include children or others under your care.
6. Next, you'll provide details about your income sources. For each income source (primary employment, secondary employment, etc.), indicate whether you receive income by marking 'YES' or 'NO'. For each 'YES' response, fill in the amount and the frequency of payment (hourly, weekly, monthly, yearly). If your income is hourly, specify your average hours worked per week.
7. For income sources such as alimony, child support, pension, and disability, repeat the process of indicating 'YES' or 'NO', and provide the corresponding amounts and frequency.
8. In the 'Other' section, specify any additional income sources you may have. Again, indicate whether you receive this income and provide the amount.
9. You will need to confirm that you understand the proof of income requirements. By signing the section provided, you affirm that the information is correct and that you will provide necessary documentation like W-2 forms and current pay-stubs if requested.
10. After completing the form, review all the provided information for accuracy. Once satisfied, save your changes. You may also choose to download, print, or share the form as needed.

Complete your Sliding Scale Application Form online to access reduced fees and support services.