• Self Information

    Please provide the requested information about the individual that is applying for the Sliding Discount Program.
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  • Make sure to include all sources of income in the weekly salary calculation. Weekly Salary Calculation Tool
  • Spouse and/or Partners Information

    Please provide the requested information of your spouse and/or partner that lives at the same household.
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  • Household Dependents

    Relatives over 18 (that are not full-time students) are not eligible to be used as dependents for this application process.
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  • Household Totals

    Your total number of household members and combined income will automatically be calculated in the fields below.
  • You will also need to provide one of the following proof of income, for those individuals listed within the application: Pay Stubs showing last four weeks of income Completed Employment Verification Form Unemployment Compensation showing last four weeks of income Workers Compensation showing last four weeks of income Social Security Income (SSI) Disability or SSI Benefits Letter Documentation from a Local, State or Federal Agency Letter of Support from Charitable Organization Last year’s Income Tax Return including W-2 or 1099 (only if Self-Employed)
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