REQUIRED DOCUMENTS TO BE SUBMITTED WITH APPLICATION
2017-2018
*** PLEASE NOTE THAT YOU CANNOT MAKE MORE THAN.$50,000 A YEAR COMBINED HOUSEHOLD INCOME TO BE CONSIDERED ELIGIBLE. ***
Copy of Drivers License/Proof of Residency
Social Security number
Medicaid card
Current pay stub
1 year current 1040 Tax Returns
Self Employed: Current year 1040 and 1120 returns
1 month current bank statements on all accounts
Recommendation letter from Doctor, Therapist or Social Worker-Located in Rider Package
If you are filling out this form as a legal guardian â please provide legal documentation
IF YOU SHOULD HAVE ANY QUESTIONS OR NEED ADDITIONAL INFORMATION, PLEASE CONTACT WENDY SCHONFELD
803-222-6008
.
