GARR Membership Fee Hardship Request
If your organization is experiencing financial hardship and would like to request a payment plan or modified fee arrangement, please complete the form below. All requests will be reviewed by GARR staff, and you will be notified of a decision within 10 business days.
Organization Name
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Number of beds
Certification Status
Initial Certification in Progress
Currently Certified
Seeking Re-Certification
Reason for Hardship RequestPlease describe the financial hardship and any relevant circumstances impacting your ability to pay the membership fee in full at this time:
Payment Plan Request (Optional)
If requesting a payment plan, please propose a monthly payment amount and timeline:
Please indicate the total current balance for fees:Total Amount Owed: $____________________
Requested Monthly Payment Amount: $_____
Number of Months Needed: __________
Note: All payment plans must be completed within the calendar year unless otherwise approved.
By signing below, I certify that the information provided is accurate to the best of my knowledge and that this request is being made in good faith due to financial hardship.
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