Clay Access Program Seniors 65 + up Sliding Scale Application

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Instructions:

Applications are accepted at the beginning of each session

Completed applications can be submitted via email, in person, or by mail.

Assistance is available if you need help filling out this form.

Applications are confidential and will be reviewed using a neutral, equity-centered process.

Sliding Scale tuition opportunities are contingent on availability and funding.

Sliding Scale tuition for Seniors is based on the following household income levels:

Less than $20,000: materials fee only ($60)

$20,001 – $40,000: Senior pays 25% tuition

$40,001 – $60,000: Senior pays 50% tuition

$60,001 – $80,000: Senior pays 75% tuition

$80,001+ : Senior pays full tuition

Clear form

Never submit passwords through Google Forms.

This form was created inside of ArtShack Brooklyn.

Does this form look suspicious? Report