Reduced Fee Calculator

The following is a Reduced Fee Calculator.

The following calculator will ask your pre-tax/take-home income, your family's pre-tax/take-home income, and how many people are supported by this income. It is okay to estimate these, but try to be as accurate as possible.

For the purposes of this calculator, household is defined as people who:

share financial responsibilities (such as childcare, groceries, car insurance)
live in the same dwelling
may file taxes together
have a relationship beyond "roommates" or "friends", such as family, parent-child, significant other/spouse, etc.

Disclaimer: Completion of this form does not guarantee reduced rate availability.

Client Name *

First NameLast Name

Date of Completion*

Date

At what frequency do you want to START sessions*

Session frequency can always increase or decrease

What is YOUR average monthly gross income (pre-tax)?*

Will anyone else in your household be helping you pay for sessions or will anyone else's income be used toward session fees, such as a parent, spouse, or significant other?*

YesNo

What is the combined average monthly gross income from all adults in the household (pre-tax) who contribute to shared expenses?

How many adults contribute to your household’s income (including you)?*

How many people (adults and children) are supported by this income (NOT including you)?*

Client Annual Income

Household Income

Client Percentage of Adults Contributing to Household Income

Additional Contributing Adults

Client Personal Income Percentage of Household Income

Dependents

Dependent Percentage for Deduction

Dependents Income

FPL Income

Based on your income and household size, your recommended weekly rate is $150.

Based on your income and household size, your recommended weekly rate is $125.

Based on your income and household size, your recommended weekly rate is $100.

Based on your income and household size, your recommended weekly rate is $75.

Based on your income and household size, your recommended bi-weekly rate is $150.

Based on your income and household size, your recommended bi-weekly rate is $125.

Based on your income and household size, your recommended bi-weekly rate is $100.