Financial Assistance "*" indicates required fields NameThis field is for validation purposes and should be left unchanged.Thanks for using our Eligibility Checker for Financial Assistance! Answer the following questions to see if you may be eligible for a discount on your Sleepy Eye Medical Center bills.Name* First Last Date of BirthIncluding yourself, how many people are in your immediate family?*“Family” is defined as a group of two or more people who reside together and who are related by birth, marriage (including legal common law spouse), or adoption. Dependents over the age of 18 will only be considered in the family size calculation if they are listed on the previous year’s tax return.Please enter a number from 1 to 10.What is your estimated gross MONTHLY household income?*This is current household monthly income before taxes.Please enter a number from 0 to 1000000.Phone # For Text (Optional)Family AdditionalsFamily Additional Total 5680Yearly Rate 15960Calculated % FPLAnnual Income
