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      · Letter summarizing the situation and the financial hardship created by it
      · The amount of the need
      · The amount being requested
      · What the market center has done to provide financial and other assistance to the applicant
      · The market center’s plans for continued assistance, if needed
      · Two most recent signed federal income tax returns in their entirety with 1099s and/or W-2s attached
      · Copies of most recent statement(s)/bill(s) for assets and liabilities
      · Copies of most recent statement(s)/bill(s) for income and monthly expenses
      · Copies of bills for medical (or other) and/or living expenses which have been incurred as a result of the situation
      · Signed physician’s statement (if this a medical situation)
      · If the applicant has health insurance, please submit a summary of all claims from the insurance provider indicating the patient’s responsibility for the charges, if applicable
      · If the applicant has homeowner’s flood or wind insurance, please submit limits of coverage, if applicable