2026-2027 Financial Assistance Application

2026-2027 Financial Assistance Application - English
Use this form to apply for financial assistance by completing all required sections. Incomplete applications will not be accepted. Please don't forget to upload your photo ID as well as proof of your household income. If you are not using your tax return, then please upload the letter you received to begin receiving services or proof of claim if you are using one of the other qualification methods. If you have any questions, please send email to FAQuestions@drd.us.com.
Financial Assistance Application Form

Valid from July 1, 2026 - June 30 2027
Section 1: Applicant Information
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Section 2: Household & Income Information
Family Size
Family Income (current yearly income from all sources)
Section 3: Income Verification
Income Verification - Document Type (select all that apply) NOTE: Photos of CalFresh or MediCal cards will not suffice, official letters of approval ONLY.
Section 4: Applicant Certification
I certify that the information on this form is accurate and complete and understand it may be subject to verification. I have attached proof of my eligibility.
Applicant Signature
Signature Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Section 5: Individuals to Receive Assistance

Include yourself if you are interested in receiving assistance. If you do not want assistance for yourself, do not include your name.
Individuals to receive assistance (up to 5)
Section 6: Approval Notification Contact

This is the information we will use to let you know your application is approved - look for award letter by email
Adult/Parent Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
File Upload - Photo Identification

Cancelof
File Upload - Income Verification

Cancelof
Should be Empty:

2026-2027 Financial Assistance Application - English

Financial Assistance Application Form

Section 1: Applicant Information

Section 2: Household & Income Information

Section 3: Income Verification

Section 4: Applicant Certification

Section 5: Individuals to Receive Assistance

Section 6: Approval Notification Contact