Equity Access Application
First name
Last name
Email
Which best describes your financial situation?
I can meet my basic needs comfortably.
I can meet my basic needs but have limited expendable income.
I sometimes struggle to meet my basic needs and have little expendable income.
I am currently experiencing financial hardship that impacts my ability to meet my basic needs.
Are any of the following factors currently impacting your financial flexibility? (Select all that apply)
Physical or mental health challenges
LGBTQ+ identity
Disability or chronic health conditions
Caregiving responsibilities
Single-income household
Systemic barriers impacting access to finances (e.g., racism, sexism)
Student or low-income
Other
What percentage of your monthly income goes toward essential expenses (housing, food, medical, etc.)?
Less than 50%
50%–75%
75%–90%
More than 90%
Are you committed to fully engaging in this program if awarded the sliding scale rate?
Yes, I am committed to completing the program to the best of my ability.
No, I am unsure about my ability to commit.
Do you consent to the information in this application being used to improve accessibility and community support initiatives? (Your individual information will remain confidential.)
Yes, I consent to my information being used in aggregate to help others.
No, I prefer my information to be used for application purposes only.
What would accessing this program at a sliding scale rate help you achieve, and why is this important to you?
If approved, which payment tier best reflects your current needs?
75% of the List Price
50% of the List Price
25% of the List Price
I'm not sure
Anything else you'd like to share?
Submit
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