Financial Evaluation Form

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

ANGER MANAGEMENT SPECIALISTS

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TEXT 805-242-2502

IMPORTANT NOTE:

Requesting aid does not guarantee approval.
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.

Total money you spend monthly with description (example: Rent $1200, Food $80, Gas $60, etc) *

If you work, how much do you make approx each month?

Name: *

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

If you do not work, how much do you live on approx and with what? (EX: CalFresh, EBT, General relief, family helps? and how much each month

OR PRINT

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If you say you have "$0, no income", please tell us how much your spouse/partner helps you income? If none, you will need to ask your family to help you with funds. We can help a little but it is still your responsibility to try to ask. Thank you

What is your financial situation?: F/T or P/T employed? Temporarily unemployed, Homeless, live at shelter or in-patient recovery, General Relief? permanently disabled (SSI), WorkComp, retired, family support? Etc

If you areF/T or P/T EMPLOYED, please send any copies to amsbip@gmail.com:

Two recent pay stubs or
Current bank statement or
Letter from employer or
Tax return

If you are UNEMPLOYED, homeless, at shelter, at in-patient recovery, disabled, work comp, or retired. Please send any statement of social aid to amsbip@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

Email: *

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