Financial Assistance Application

D.A.Y.S Non-Profit Training Program

Household Information

Employment Status (check one)

Employed

Unemployed

Student

Other

Monthly Household Income: $

Number of Dependents:

Assistance Request:

Please explain why you are applying for financial assistance and how this program will benefit you:

Supporting Documents (attach copies)

Proof of Income (pay stub, tax return, etc.)

Proof of Residence (utility bill, lease, etc.)

Other (please specify)

Agreement

I certify that the information provided in this application is accurate and complete. I understand that submitting false or incomplete information may disqualify me from receiving financial assistance.