Get Financial Assistance Application

Filling out the Financial Assistance Application online can simplify the process of seeking financial support. This guide provides clear, step-by-step instructions to help you accurately complete the form and submit it for consideration.

Follow the steps to fill out the Financial Assistance Application online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the applicant's personal information, including their name, social security number (SSN), and date of birth (DOB). Ensure accuracy to prevent processing delays.
3. Provide the spouse's personal details if applicable, including their SSN and DOB.
4. Fill in your street address, city, and state to establish your residency.
5. Enter your phone number and cell phone number for contact purposes.
6. Indicate your household gross monthly income by including all sources of income such as salary, wages, child support, benefits, and any other income. Make sure to provide an accurate total.
7. If your income is zero, provide an explanation in the specified area to clarify your financial situation.
8. List any other resources or property values that may contribute to your overall financial picture, including checking account balances and savings account balances.
9. Detail your dependents by entering their names and dates of birth, ensuring all relevant information is included.
10. Indicate any other financial assistance programs for which you applied in the last year, including their current status.
11. Answer the Title 19 eligibility questions, marking 'yes' or 'no' for each based on your circumstances.
12. Use the space provided to attach any supporting documents that may provide additional context about your current situation.
13. Read and affirm the client affirmation section, ensuring all statements are true and complete. Sign and date the form to validate your application.
14. Return your completed application along with required supporting documents, such as tax returns or denial letters, as outlined in the form instructions.
15. Finally, you may save your changes, download the completed application, print it, or share it as needed.

Start the process today by filling out your Financial Assistance Application online.