Your Family

When considering financial assistance eligibility, we consider your family’s size and unique income situation. Your household includes everyone living with you related by blood, marriage and/or legal status. We take your privacy seriously, and this information will remain confidential.

If you don't have a copy of the application, you can download it here: Download Application

Family Information

Your family’s expenses give us a better picture of your unique financial situation. In this section, you'll provide information about your family members, their relationship to you, and their incomes.

Family size

To determine your family size, tally yourself and all the members of the household who are related by blood or law. That can include:

Grandparents
Cousins or other biological relatives that live in the same home
Spouses
Foster children or adopted children that are legally part of the family

Unrelated roommates are not considered part of the family. Neither are children (of any age) who live somewhere else, even if you support them financially.

Financial application form field for family size.

Family members’ income sources

You’ll need to provide proof of income for every adult 18+ in your household. Income from unemployment, worker’s comp, child support, Social Security, etc., even for family members who aren’t working right now, count and should be included. If someone has no income of any kind, please respond “N/A” so we know the field wasn’t mistakenly left blank.

Financial assistance application form field 5

Family members’ income

Here, list each adult’s total monthly income before taxes. That could mean looking at the “gross pay” line on a paystub or adding up various income streams.

Also applying for financial assistance

If other members of your family may need financial assistance for medical bills from Providence, check this box. We’ll use this same application to see if they also qualify for financial assistance.