Rider Assistance Application Form Rider Financial Assistance Application Through fundraising activities and grants from private foundations, Main Stay is able to offer assistance to qualifying clients on a sliding scale based on income. Main Stay uses the income levels as established by the Illinois Free and Reduced Lunch Program. Current information on these income levels is listed below. Riders who meet the criteria for free lunch based on income level will pay $10 per lesson. Riders who meet the criteria for reduced lunch based on income level will pay $15 per lesson. Riders will be eligible to apply for funding each year, however, funding may only be awarded to eligible riders for up to three years. Funds are limited and will be awarded based on the sole discretion of Main Stay. Riders must stay current with their payments and may lose their assistance due to excessive cancellations or nonpayment. Financial assistance may be awarded for 1, 2, or 3 riding sessions of the current year based on the number of sessions selected by the rider. The same lesson fee is applicable for all sessions. Riders need to complete a Financial Assistance Application annually and assistance is not guaranteed each year. 1.3 (Free Lunch) $10/Lesson 1.85 (Reduced Lunch) $15/Lesson Family of 1 17,677 or less 25,142 or less Family of 2 23,803 33,874 Family of 3 29,939 42,606 Family of 4 36,075 51,338 Family of 5 42,211 60,070 Family of 6 48,347 68,802 Family of 7 54,483 77,534 Family of 8 60,619 86,266 Client Name * Client Name First First Last Last Client resides with * Mother Father Both parents Guardian Self/Spouse Client's marital status * Married Single Divorced/Separated Widowed Number of people in the household (including children) * Client submits his/her own Federal and State taxes? * Yes NoNo If no, who claims the client for tax purposes The client or individual who claims the client for tax purposes must submit a current income tax return along with the application. Please list the amount received from each of the following sources for all family members that apply: Annual Gross Income $ Additional person(s) in family Annual Gross Income $ Public Aid $ SSI/SSDI $ Alimony $ Child Support $ Other, please explain $ Please describe any extenuating circumstances that contribute to your need for assistance Which session(s) are you requesting financial assistance? * Session #1 (Winter) Session #2 (Spring/Summer) Session #3 (Fall) The Mental Health Resource League is a large contributor to our Rider Assistance Fund. Volunteers are needed for their craft fairs and the funds given to Main Stay are directly related to the number of volunteers who assist at their events. Please indicate which fundraising activity you will participate in * Fair Diddley (May) Fall Diddley (October) Income Tax file * Drop a file here or click to upload Choose File Maximum upload size: 3.15MB Information provided in this application will be kept confidential. I certify that the information provided in this application is correct to the best of my knowledge. Signature * Clear Date reCAPTCHA If you are human, leave this field blank. Submit 2023 Rider Registration Form2023 Session Payment2023 Rider Financial Assistance Application2023 Saddle Up Registration and Release
