Helping All Students to Independence - Company Message
All information will be held confidential and will not be sold to third parties. This information is for our records, and must be reported to the IRS.
Name:
Telephone: home, cellular, and email.
Address:
A school or an affiliate referred me. If not, who did?
Have you recieved assistance before?
Are you presently employed, and if so, how much is your monthly income?
Do you receive any federal assistance? If so, what and how much is it? Such as unemployment, food stamps, etc...
Please explain what type of assistance is needed, and how will this grant if available will help.
 
H.A.S.I. works together as one people; therefore, at no time will we discriminate
 on the bases of "gender, race, class, economic status, ethnic background, sexual orientation, age, physical ability, or cultural and religious background.
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