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DTL Financial Assistance for Individuals

What's your email?

What's your first and last name?

What is your date of birth?

What is your address?

What neighborhood are you located in?

What is your race?

What is your gender identity?

What is your monthly income?

If you had a 25% - 50% discount toward our programs, what would you purchase over the next year?

If you had a 25% - 50% discount toward our programs, what would you purchase over the next year?
A
B
C

How would this program(s) help you?

Anything else that you would like to add, or any special circumstances you would like us to know about?

Are you currently actively enrolled in a Federal or State Assistance Program? If so, which of these below?

Are you currently actively enrolled in a Federal or State Assistance Program? If so, which of these below?
A
B
C
D
E
F
G

If you are part of a Federal or State Assistance Program:

Please provide documentation such as a valid ID card, approval letter, or benefit statement from your assistance program (e.g., Medicaid, SNAP, CHP+, LEAP, TANF). Applications submitted without documentation will be considered as not receiving assistance.