Agreement:
If awarded a discounted rate or scholarship, you will be notified in writing. Rates are based on family size, income and current Federal Poverty Guidelines.
If receiving a sliding fee discount and there is hardship paying the discounted rates contact Brighter Together about other payment plan or options.
Approved sliding fee discounts or scholarships will have a limit on the amount of services or supports provided. Applicants may reapply for support at the conclusion of the service or support.
I agree to all of the Sliding Fee Discount and Shining Star Scholarship program requirements. I understand that providing false information of any kind will result in immediate termination of this agreement and I will be required to pay the agency’s full rate for each date of service provided. I certify that the family size and income information shown above is correct. I understand that it is the responsible party's obligation to pay any balance at each visit unless otherwise specified.