RSA Financial Aid Application Form
Your Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Student's Name (if different than above)
*
First Name
Last Name
Student's Age
*
Household Size
*
1-2 Persons
3-4 Persons
5-6 Persons
More than 7
Total Monthly Income
*
Under $3500
$3,600-5,500
$5,600-6,500
$6,600 or More
Current Employment Status
*
Retired
Student
Unemployed
Self-Employed
Employed Full-Time
Employed Part-Time
Are you currently receiving public assistance? If so, which one?
*
EBT
CalFresh
Medi-cal
SSI/SSDI
Housing Assistance
None of these apply
More then one of these
How often do you expect to visit us?
*
Once per week
Twice per Week
Thrice per week
Briefly explain your financial situation
*
What does art mean to you and why do you want us to help you?
*
Please upload any supporting documents such as your CalFresh or EBT card, Medicare, Student ID, SSI/SSDI documents, housing assistance, etc.
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