Try to answer as many relevant questions on this sheet and send it back. With the answers to these questions, we should be able to get a good start on how we can help assist you with your current needs, and if you qualify for our assistance program. Answer honestly, this is our policy. If it is found later that any of this information was false, or information withheld, you could be disqualified from receiving our services. Please note it could take up to 7 business days to process your request.