Outreach

The Dawning Institute provides Outreach assistance for any client whose gross family income is up to 200% of the Federal Poverty Level (FPL).

WHO SHOULD FILL OUT AN APPLICATION?

Fill out the application if:

Total household income is the SAME or LESS than the amount on the chart
You receive Food assistance, Housing assistance, awarded Medicaid, on disability, or other state/federal benefits.

Total household income is the SAME or LESS than the amount on the chart
You receive Food assistance, Housing assistance, awarded Medic aid, on disability, another state/federal benefits.

Federal Poverty Level (FPL).

Family size	2023 income numbers	2024 income numbers
for individual	$14,580	$15,060
For a family of 2	$19,720	$20,000
For a family of 3	$24,860	$25,820
for a family of 4	$30,000	$31,200
For a family of 5	$35,140	$36,580
For a family of 6	$40,280	$41,960
For a family of 7	$45,420	$47,340
For a family of 8	$50,560	$52,720
for a family of 9	Add $5,140 for each extra person	Add $5,380 for each extra person

TO apply you will need :

Government-issued identification
Income documentation
(a)pay stubs (3 months) and or
(b)bank statement (3 months) and or
(c)tax return filling for the previous year
If you are a SNAP participant, you will only be asked for your SNAP Approval Letter forBenefits, including both the cover page and calculation page.

PLEASE NOTE

We cannot guarantee that you will qualify for financial assistance, even if you apply.
Within 14 calendar days after we receive your completed application and documentation, we will notify you if you qualify for assistance.

Client First Name

Client middle Name

Client Last Name

Gender

Mailing Address

Area Code Phone Numbers

Femalemale

FAMILY INFORMATION

List family members in your household, including yourself. “Family” includes people related by birth, marriage,or adoption who
live together.

FAMILY SIZE (how many are living in the same household)

All adult family members’ income must be disclosed. Sources of income include, for example: - Wages - SSI- Unemployment - Self-employment - Worker’s compensation - Disability - Child/spousal support
- Work study programs (students) - Pension - Retirement account distributions - Other (please explain)
Income documentation
If you are a SNAP participant, you will only be asked for your SNAP Approval Letter forBenefits, including both the cover page and calculation page.

Name

Date of birth

Number of family size

Relationship to client

All adult family members’ income must be disclosed. Sources of income include, for example: - Wages - SSI- Unemployment - Self-employment - Worker’s compensation - Disability - Child/spousal support
- Work study programs (students) - Pension - Retirement account distributions - Other (please explain)

REMEMBER: You must include proof of income for every household member where applicable with your application. Income verification is required to determine financial assistance.

Additional information

Please attach an additional info, if there is other information about your current financial situation that you would like us to know, such as a financial hardship, seasonal or temporary income, or personal loss. This also includes any additional family that are not listed above with the same questions and disclosures.

CLIENT AGREEMENT

I understand that The Dawning Institute may verify information by reviewing and obtaining information from other sources to assist in determining eligibility for financial assistance or payment plans.
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I affirm that the above information is true and correct to the best of my knowledge. I understand if the information I give is determined to be false, the result will be denial of Outreach, and I will be responsible for and expected to pay for services provided.

Certify

Washington State Compliant Online Financial Privacy Notice and Statement
The Dawning Institute LLC ("we," "us," or "our") respects your privacy and is committed to protecting your financial information. This Financial Privacy Notice and Statement outlines our practices for collecting, using, sharing, and protecting your financial information in compliance with Washington State law.
Collection of Financial InformationWe may collect the following types of financial information when you use our outreach application:
1. Personal Identification Information: Name, address, phone number, email address.
2. Financial Information: Bank account details, payment card information, transaction history.
3. Other Information: Social Security number, income, employment information, and other related data necessary to provide our services.

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Use of Financial InformationWe use your financial information for the following purposes:
1. Service Provision: To provide, manage, and improve our services.

2. Transaction Processing: To process payments and transactions.
3. Customer Support: To respond to your inquiries and provide support.
4. Legal Compliance: To comply with applicable laws, regulations, and legal processes.
5. Security: To prevent, detect, and investigate fraud and security breaches.
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Sharing of Financial InformationWe do not sell your financial information. We may share your financial information with third parties only in the following circumstances:
1. Service Providers: With third-party service providers who perform services on our behalf, such as payment processors and data storage services.
2. Legal Requirements: When required by law, regulation, or legal process, or to protect our rights, property, and safety or that of others.
3. Business Transfers: In connection with a merger, acquisition, or sale of all or a portion of our assets.
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Security of Financial InformationWe implement reasonable security measures to protect your financial information from unauthorized access, use, or disclosure. No data transmission over the Internet or electronic storage system can be guaranteed to be 100% secure.
Changes to This NoticeWe may update this Financial Privacy Notice and Statement from time to time. We will notify you of any significant changes by posting the new notice on our application and updating the effective date. Your continued use of our application after any changes indicates your acceptance of the updated notice.

Effective DateThis Financial Privacy Notice and Statement is effective as of 05/30/2024

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