COMPLETED APPLICATION FOR ASSISTANCE FORM, HEALTH STATUS REPORT BY HEALTHCARE PROVIDER, RECENT PROOF OF INCOME FOR ALL HOUSEHOLD INDIVIDUALS, COPY OF CURRENT LEASE OR MORTGAGE STATEMENT, AND A COPY OF FAMILY COURT SUPPORT IF YOU ARE MAKING OR RECEIVING CHILD SUPPORT AND/OR ALIMONY PAYMENTS.

MUST BE A REGISTERED NURSE WITH A DOCUMENTED MEDICAL DIAGNOSIS THAT TEMPORARILY OR PERMANENTLY PROHIBITS THEM FROM WORKING.