Family/Individual Application

Notes for Completing Application (Individual/Family)
  1. If you are requesting funds to buy a specific item, please include a cost estimate in addition to a detailed description of the item and prioritize in order of importance
  2. Funds will not be granted for general operating expenses or utilities
  3. Submit W-2s for the last two years
    • Fax It: 620-356-4306
    • Or if you are mailing your application, include them.
  4. To complete your application:
    • Submit online and fax us all relevant additional documents: 620-356-4306 -or-
    • Mail your completed application with additional documents to
      Brandi Fowler, PEAR Coordinator
      P.O. Box 368, Ulysses, Kansas 67880
  5. You do not need to sum the columns yourself. When all value are filled in, press the button calculate the amount columns and generate a summary.
  6. This form has been verified to render properly in IE7, FF2, FF3, and Chrome.