Apply - Juan de Fuca Foundation for the Arts

Financial Assistance

Name
Head of Household
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone
Email
Date of Birth
MM slash DD slash YYYY
If you are under 21, are you a legal dependent of your parents?
- Yes
- No
List all family members living in your household that are financially dependent upon you or that share household expenses and their monthly income.*
Name Age Relationship Pay Schedule Monthly Gross Household Income

Failure to provide proof of income for all household members can delay processing.
Required Documentation*
Max. file size: 256 MB.
Please provide one of the following: (attach as a PDF) Federal Income Tax Form and one month CURRENT pay stub Current unemployment stub Current Social Security Retirement Statement Current Supplemental Security Income (SSI) GAU/GAX General Assistance Statement

Name	Age	Relationship	Pay Schedule	Monthly Gross Household Income