Apply for MyClearStep Financial Aid

Apply for MyClearStep Financial Aid

If you are facing financial challenges, fill out the form below to check your eligibility for a reduced fee.
Name

First NameLast Name
Email
example@example.com
To be eligible for financial aid, you'll need to be working with a clinician. Please enter their name and email address here.

Clinician first nameClinician last name
Clinician email
example@example.com
What is your current employment status?
What is the current employment status of your spouse?
How much do you and your spouse (combined) earn from working on a monthly basis? (Please include gross wages, salaries, income from business, tips, etc.)
USD/month
Please enter the monthly income of you and your spouse (combined) from the following sources (enter "0" where not applicable):
Social security (including SSI): USD/month
Disability:  USD/month
Unemployment benefits: USD/month
Support / Alimony: USD/month
Public assistance or veterans' payments: USD/month
Survivor benefits:   USD/month
Pension or retirement income: USD/month
Interest, dividends, rents, royalties, income from estates or trusts: USD/month
Are you currently serving on active duty in the U.S. Armed Forces for purposes other than training?
Are you a veteran of the U.S. Armed Forces?
How many children do you have who receive more than half of their support from you? (enter "0" if none)
How many dependents (other than your children or spouse) live with you and receive more than half of their support from you? (enter "0" if none)
In the last 2 years, did you or anyone in your household receive benefits from any of the federal programs listed?

Other
Do you live in a rural area? (A "rural area" is defined as having a population of less than 50,000 area in the surrounding 25 miles)
Are you a person of color?
Are you a member of the LGBTQIA+ community?
Should be Empty: