RSA Financial Aid Application Form

RSA Financial Aid Application Form
Your Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Student's Name (if different than above) *

First NameLast Name
Student's Age*
Household Size*

1-2 Persons3-4 Persons5-6 PersonsMore than 7
Total Monthly Income*

Under $3500$3,600-5,500$5,600-6,500$6,600 or More
Current Employment Status*

RetiredStudentUnemployedSelf-EmployedEmployed Full-TimeEmployed Part-Time
Are you currently receiving public assistance? If so, which one?*

EBTCalFreshMedi-calSSI/SSDIHousing AssistanceNone of these applyMore then one of these
How often do you expect to visit us?How often do expect to visit us?*

Once per weekTwice per WeekThrice 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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Please verify that you are human*
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