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How to Apply WITH Financial Help

Start Here - What's On this Application

An overview of what's on this application and how to navigate it online.

1. Sign In - Choose an Application

Choose an application, read and understand the privacy warning.

2. Applicant Details

Entering information about the primary contact, tips and help with this section.

3. Household Information

People to include in your household and entering information about your household.

4. Household Income

Reporting current income for each person listed on your application.

5. Employer-Sponsored Insurance

Information about household members who have access to employer-sponsored insurance (ESI).

6. Summary and Signature

Reviewing your application, signing and submitting your application.

7. Eligibility Determination

After you submit your application, you'll see the eligibility screen telling you if you qualify for financial assistance.

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