Reduced Fee Request

Name*
First Last
Client Name
First Last
Email*
Phone
Service Requested*
We can provide you more specific fee information based on the service you are requesting if you are eligible for a reduced fee - full fee is displayed. A payment plan would divide the fee into six (6) equal payments.
Annual Income*

You may estimate, but we will require proof of income at the time of service (tax forms, pay stubs, etc.).
Number in Household*
Dependents being claimed on parent's income tax returns, such as college students up to age 24, may include all still living at home.
File
Max. file size: 2 MB.
If you have an electronic copy of your annual tax return or recent pay stubs, you may upload a copy here.

Korn Learning, Assessment, and Social Skills Center College of Education, Health & Human Sciences