Financial Assistance Application

Financial Assistance Application

Thank you for your interest in our program! For over 40 years, our organization has been committed to providing services to clients who will benefit, regardless of ability to pay. Ability to pay is determined by income level and other contributing factors specific to your family situation. Availability of funds depends on the number of individuals requesting assistance in relationship to the funds raised each year for this purpose. Requests for assistance are kept strictly confidential; if financial assistance is approved, you will be contacted via email with a discount code to use during the registration process. Please note that we do ask families to reapply annually for assistance. If you are in need of financial assistance but unable to complete the form for any reason, please reach out to us via email or phone and we're happy to help.
Your Name:

First NameLast Name
Client Name:

First NameLast Name
Email Address:
Email
Please describe the benefits you or your child have received from NCTRC services. If you are a new client, what benefits are you hoping to gain from participation at NCTRC?
Describe any special financial circumstances that affect your ability to pay program fees:
Upload a copy of pages 1 and 2 of your most recent tax return or other documentation. Please hide social security numbers and any other sensitive information:

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How many members in your household?
Do any other members of the household have extra support needs?
i.e. disabilities or other challenges
I hereby certify that the information given above is true, accurate, and complete to the best of my knowledge. I am aware that if any of the information provided is incorrect my financial assistance may be terminated. I understand that submitting this application does not guarantee an award of financial assistance.
Signature*

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