Please note that Financial Assistance is only available for the PLUS membership level.

Main Street strives to make its programs available to all regardless of ability to pay. Financial assistance is limited to membership fees and is provided based on level of need. If you would like to request a printable copy of this application, please email us here.

This application is to be completed fully with required supporting documents attached. A personal interview may be requested before consideration of your application.  The information you provide in this application will be held in strict confidence and will need to be updated annually. Incomplete applications cannot be processed.

Eligibility and awards will be determined within 1 week of application submission.

You may SAVE your form and complete it at a later date, This option is available at the bottom of the form.

Main Street Connect Application for Financial Assistance

"*" indicates required fields

What level of financial assistance are you requesting?*
Name of Applicant*
Applicant's Email*
Applicant's Address*
What is your marital status as of today?*
Are you a U.S. citizen?*
Please describe your current living situation*

Share names, gender, birthdate, relationship to applicant, school, employment information for each person.
What is the highest level of schooling you have completed?*

Automobiles—own, lease year, make, model, payment; Bank accounts—list all bank/money market/cd’s/brokerage accounts (financial institution, type of account, account numbers; Real Estate Holdings—home, market value, how many years; second home, market value, how many years: Family Retirement plans—current year contributions, total value (for all family members); Other Assets—list and value
Salary; Child Support; Alimony/child support; Trust, Estates, Partnerships; Unearned Income (interest, dividends, pensions, retirement); Unemployment compensation; Social Security; Welfare/food stamps; Disability, workman’s comp, insurance claims; Gifts, money or property inherited or willed; Scholarships/grants - DDA funding; Other, please specify
Rent or Mortgage; Real Estate taxes; Maintenance/association fees/landscaping; Utilities (Electric, gas, water, garbage); Cable/internet; Telephone (land and cell); Other Utilities; Food/groceries; Clothing; Laundry/dry cleaning; Household supplies; Medical/dental insurance and unreimbursed expenses; Recreation and Entertainment; Insurance premiums (life, auto, home and other); Car payments; Car repairs/gas; Credit card payments; Alimony/child support; Payment for other dependents living with you; Child care; Child support; School tuition; Travel; Subscriptions (paper, Netflix, Amazon Prime); Charitable contributions; Other expenses, please specify
Are you currently involved in any litigation?*
When submitting these supporting documents, please be sure to mark out all social security numbers, tax ID numbers and/or credit card numbers prior to submitting your paperwork.
Drop files here or
Max. file size: 50 MB.
    When submitting these supporting documents, please be sure to mark out all social security numbers, tax ID numbers and/or credit card numbers prior to submitting your paperwork.
    Drop files here or
    Max. file size: 50 MB.
      When submitting these supporting documents, please be sure to mark out all social security numbers, tax ID numbers and/or credit card numbers prior to submitting your paperwork.
      Drop files here or
      Max. file size: 50 MB.
        Declaration