Financial Evaluation Form

MAKE A PAYMENT

court certified batterer intervention and anger management programs for Santa Barbara County

ANGER MANAGEMENT SPECIALISTS

TEXT 805-242-2502

FINANCIAL DECLARATION FORM TO EVALUATE YOUR SITUATION:

Application will not be process if form is incomplete and without documentation
Completion of financial declaration form does not mean you enrolled. Must Enroll first.

What is your financial situation? *

UPLOAD DOCUMENTS

If you work, what is your monthly earning? *

If you do not work, what is your social aid? CalFresh, EBT, General relief, family helps? and how much each month *

DOWNLOAD FORM

If you say you have $0 income and $0 expenses, how is your family or spouse helping you? Describe the value of their help. *

Email: *

Check here to receive email updates

Expenses per month (example: Rent $1200, Food $80, Gas $60, etc) *

IMPORTANT TO DO:
If client is employed, please send any copies to amsbip (at) gmail.com:

Two recent pay stubs or
Current bank statement or
Letter from employer or
Tax return
Family letter of financial support

If client is unemployed, chronically homeless, or residing in shelter, at in-patient recovery, or is disabled. Please send any statement of social aid to amsbip (at) gmail.com

CalFresh - EBT card or General relief or
Shelter residency letter or
Unemployment benefits or
Social Security / Disability or Work compensation or Retirement benefits or
Family letter of financial support

Name: *

Upload any proof of income or email us instead amsbip@gmail.com *