Follow the steps to complete your application successfully.

1. Press the ‘Get Form’ button to access and open the Financial Assistance application in your document management software.
2. Begin by filling out the Financial Assistance Application section. If you are part of a state program like Food Stamps or WIC, complete just the first page and include proof of your participation, as this may lead to your automatic eligibility for financial assistance.
3. Provide comprehensive details for everyone residing in your household. Complete all three sections indicated on the right side of the form to ensure your application is fully processed. Any missing information could delay your request.
4. Gather the necessary proof of income for all individuals in your home. Acceptable documents include your most recent tax return, pay stubs, or letters regarding disability or pension income. Make sure to send copies, as originals should not be mailed.
5. Provide proof of assets by submitting relevant documents, such as bank statements from the last three months and any investment statements you may have.
6. Make sure to review the consent section of the form. By signing, you certify that the information provided is accurate and give permission for UnityPoint Health to verify the details.
7. Finalize your application by signing the bottom of page two. If completing the form online, ensure all edits are saved.
8. Submit your completed application along with the supporting documents via mail, email, or fax as detailed in the form. Ensure to send only copies of documents, as originals will not be returned.

Complete your Financial Assistance application online today and take the first step towards receiving the support you need.