Please complete all sections below. Should a section not be applicable to you, acknowledge this by writing “N/A” in the available space. All submissions must be signed. Submitting a hardship request form is not a guarantee that an adjustment will be made.
Should you have any questions about the application, please direct them to Eve Grubb, Director of Operations.
Agreements and Acknowledgements
By initialing below, I attest that the information submitted here is true and accurate to the best of my knowledge. Intentionally providing false information will result in ineligibility for any form of hardship assistance and may impact future eligibility for financial assistance through the normal application process.