Dear Applicant:
 
You have requested the opportunity to apply for financial assistance consideration for your court-ordered community service fees. In order to better serve you please follow the directions below and upload your needed documents:
 
Documents Needed  
  • Income-provide 3 consecutive check stubs 
  • Bank Statements- provide 3 consecutive bank statements
  • Unemployment- provide current statement no older than 1 month
  • Government Assistance (GR, Welfare, SSI/SSD, TANF, Calworks) - provide current "Notice of Action". Must be dated no older than 30 days. *a copy of EBT food stamp card is not an acceptable form of verification.
  • Homeless Shelter/Resident Rehabilitation Program- provide letter on letterhead from Program Manager with Contact Information
  • Other- please explain in detail and provide documentation to support your request 
Upload all documents to your application for processing. Processing may take up to 4-6 weeks to receive an answer. You will be notified via email.
 
Name*
Address *
City*
State*
Zip*
Phone*
Email*
Case #*
Court*
County *
Court Sentence Date
Court Ordered *
Hours Required *
Due Date*
Monthly Salary/Income*
Do you receive a Disability payment?*yes   no   
Do you receive Unemployment?*yes   no   
Do you receive Child Support or Alimony?*yes   no   
Do you receive Government Aid?*yes   no   
Other Income
Total Income*
Monthly Rent/Mortgage *
Monthly Utilities (gas, electric, etc.)
Monthly Auto Payment & Insurance
Monthly Phone Bill
Monthly Credit Card/Loans
Monthly School Loans
Monthly Food Expense
Other Expenses
Please Upload 3 Consecutive Paycheck Statements *
Please Upload 3 Consecutive Bank Statements *
Please Upload other documents that may assist
Please Provide Shelter or Housing Program Letter or Documents
Please Provide Notice of Action-GR/Welfare, SSI/SSD/TANF, Calworks- No Older than 30 Days