Your Finances

When considering financial assistance eligibility, we review your monthly expenses—which could include a mortgage, student loans, car financing or other debt—to help determine what assistance we can offer. 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.

Income Information

We accept many kinds of documents as proof of income–last year’s tax returns, W-2 forms, paystubs, Social Security award letter, unemployment benefit letter, even a letter from your employer.

If you are sending your tax return, be sure to attach any schedules you may have filled out for unemployment, investment, small business or farm income, too. If you include a written statement about your income, it should come from someone else, like your employer or a relative who’s supporting you.

Expense Information

Your monthly expenses give us a better picture of your unique financial situation, so we encourage you to be as accurate as you can about your monthly budget.

Monthly household expenses

It’s okay to average or estimate your living expenses. We understand your expenses might vary month to month.

Application form field for monthly expenses

Asset Information

If you have a checking account, savings account, or other assets like stocks, bonds or a 401K, you’ll note these here.

Account balances

We know account balances fluctuate, especially with checking accounts. Just put in your current balances at the time you complete your application.

Other assets

We never ask people to refinance their homes or tap their retirement savings to pay for medical bills. In fact, in most cases and in some states, your financial assets won’t figure into your eligibility for financial assistance. Just note the types of assets you have, and we’ll follow up if we need more details.