INSTRUCTIONS

Section 1 – Personal Information Required

➤ Name
➤ Phone Number
➤ Date of Birth
➤ Taxpayer Registration Number
➤ Email Address
➤ Marital Status
➤ Mailing Address & Home Address (if different)
➤ Monthly household rent payment
➤ Length of time at this address

Section 2 – List Of Other Household Members

List the following information separately for each additional household member

➤ Name
➤ Age
➤ School attending
➤ Employer information
➤ Monthly income

Section 3 – Financial Information

➤ Name of employer
➤ Monthly income
➤ Name of employer
➤ Employer phone number
➤ Length of employment
➤ Employer address

Documentation Required To Be Submitted

Proof Of Employment

➤ Employees submit copies of 3 months of paystubs.
➤ Self-employed individuals submit a letter stating your business and monthly revenue – this must be notarized by a justice of the peace, a pastor, or a school principal.
➤ Unemployed individuals submit a letter stating as such – this must be notarized by a justice of the peace, a pastor, or a school principal.
➤ Retired individuals submit copies of 3 months of pension payments, if applicable.

Medical Expense Documentation

➤ A copy of the invoice for which payment is requested must be stamped and dated by the medical provider and submitted with this application with the date of service indicated.