Financial Assistance

  • Head of Household
  • Date Format: MM slash DD slash YYYY
  • NameAgeRelationshipPay ScheduleMonthly Gross Household Income 
    Failure to provide proof of income for all household members can delay processing.
  • 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

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