Evolve Duluth Financial Assistance Application for Membership

Financial Assistance Application for Membership
Evolve Duluth strives to make our programs and membership available to all who will benefit from them, regardless of their ability to pay. All financial assistance is granted on a sliding scale according to income and need. All information is kept confidential.

Applications are approved as funding is available. Every request is renewed every three months.
Primary Adult Applicant

First Name Last Name

Address

Phone Number

Area Code Phone Number
Email
example@example.com
Occupation
Please share why you are applying for financial assistance
Salary, wages, and tips
Unemployment Compensation
Social Security Compensation
Child Support
Housing Allowance
Other
Total Annual Income
Submit your completed Financial Assistance Application with the following:
- Current year's Federal Tax Return (Form 1040 or 1040EZ pages 1 & 2 only)
- Copies of your last two paycheck stubs
You may upload PDF documents or take a picture of the documents and upload them. Please block out your SSN.
Upload your requested documents

Browse Files

Cancel of
I did not file a Federal Tax Return based on federal government income guidelines.

Yes
I certify that this information is true and complete to the best of my knowledge. I agree to notify Evolve Duluth if my financial status changes.
Name and Date
Once we receive your application, you will receive a reply within 5 days. Thank you for applying.
Should be Empty: