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Secure Documents Form
To securely send us documents (e.g. recent paystubs), please complete this secure form. When sending photos of documents, you may find it easiest to complete this form on your smartphone.
Your Name
*
Your Email Address
*
Your Phone Number
*
Are you applying for our sliding scale?
*
No
Yes
What is your marital status?
*
Single
Married / partnership
Divorced / separated
Widowed
What is your living status?
*
Alone
With roommates
With partner / spouse
With family member
What are your monthly housing expenses?
*
Amount ($)
Rent
Amount ($)
Mortgage
Amount ($)
How many homes do you and / or your partner / spouse own?
*
What is your work status?
*
Employed / salaried / independent
Unemployed
What is your profession?
*
When did you become unemployed?
*
+
Do you own any assets such a savings, real estate, stocks / funds (excluding retirement funds) with a value greater than $25,000?
*
No
Yes
Please choose between one and ten document files to send us at once.
Please choose between one and ten document files containing your
most recent three months of paystubs and / or bank statements
.
Document Files
*
Please describe the content of your document(s) in a few sentences.
Document Contents
*
0/250 characters