Full Price Checklist: *

If 3 of the following are true, I can likely pay full price and may not need full financial support. Please check all boxes that apply to you.

I am able to meet my basic needs (food, housing, transportation)

Although it might be tight, I am able to spend some of my income on eating out, travel, entertainment, and fitness

I am able to pay rent, or I own my home or property

I am employed

I have access to financial support through family, savings, or resources in times of need

I am pursuing my passion, or higher education, and therefore have limited income by choice

None of the above

Support Checklist: *

If 2 or more of the following are true, I should request financial support. Please check all boxes that apply to you.

I do not have access to financial support from other resources, such as a partner’s income, family, or investments

I qualify for government assistance

I have a disability that has produced genuine financial hardship

I am on food stamps

I am on Medicaid

I have self screened and feel this program is appropriate for my situation. *

I am willing and able to provide written proof of all of the above if requested.

Yes

No

Name *

First Name

Last Name