Cheetah House Community Support Group Financial Assistance Request Form

Reason for request

Based on the information you provide, you will be given an immediate discount code.

The code changes quarterly. If your financial status is the same at the end of a discount period, you can redo this process to receive a new code.

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* 1. Email

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* 2. Name

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* 3. Reason for Scholarship Request (please check all that apply)

total household income is between $25-50,000 USD

total household income is less than $25,000 USD

I am a full time student

I am unemployed

I am on disability

Other (please specify)