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| You may qualify for free services based on the requirements below. | | | | | | | | | | | | | | | | | | Please include one of the following proofs of income. | | | | | | | | | | | - Income Tax Return (Form 1040) or (all) W2 forms from last year.
| | | - Check stubs for the 3 months prior to service. (Gross Income)
| | | - Letter or print out from your employer.
| | | | | - Unemployment Claim Information
| | | | | - Social Security - Welfare Eligibility Letter
| | | | | - Disability - Retirement - VA Checks
| | | | | | | | | | | | | | | | | | | | | | Size of Family | Gross Annual Family Income | | Weekly Income | | 1 | | | $21,660 | | | | $416/wk | | 2 | | | $29,140 | | | | $560/wk | | 3 | | | $36,620 | | | | $704/wk | | 4 | | | $44,100 | | | | $848/wk | | 5 | | | $51,580 | | | | $991/wk | | 6 | | | $59,060 | | | | $1135/wk | | 7 | | | $66,540 | | | | $1279/wk | | 8 | | | $74,020 | | | | $1423/wk | | | | | | | | | | For each additional family member, add $3,740 to the gross annual income. |
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