Mesa Arts Center | Fee Assistance Application

Mesa Arts Center | Fee Assistance Application

Thank you for your interest in taking classes at Mesa Arts Center! Fee Assistance is a program of the City of Mesa/Mesa Arts Center to provide increased access to Mesa residents only. Applicants must meet 200% of the federal poverty level to be considered. Applicants must provide proof of residency and proof of income.

Fee Assistance provides 50% off the cost of the class - applicants are then responsible for the remaining 50% of the class cost and any materials required. If you have questions please feel welcome to contact ArtStudioClass@mesaartscenter.com.
We're sorry, the program associated with this form is no longer accepting applications, you can visit www.mesaaz.gov/help for more information.
Applicant Information
Applicant Name:*

First NameLast Name
Date of Birth:*

MonthDayYear
Phone Number:*
Applicant Email:*
example@example.com
Applicant Address:*

Street Address

Unit

CityState

Zip Code
Household Information
Are you a resident of the City of Mesa?*

YesNo
How many people currently live in your home?*
All people in your household, not just family including yourself.
Ethnicity:*

CaucasianAsianBlack/African AmericanAmerican IndianNative AlaskanPacific IslanderOther
Hispanic:*

YesNo
Preferred Language:*

EnglishSpanishOther
Gender:*

MaleFemaleOther
Disability:*

YesNo
🛈 NOTE:

If you receive rental assistance from Section 8 you will not be eligible for rental assistance.
Please list all household member’s names (including the applicant).

Click the +Add Another Member button to add as many household members as needed.
Add ALL Household Members (adults/children, not just family members). Please include yourself in this list.)*
Total Annual Income
Upload Required Documents

Upload all required documents for ALL household members here. Your application will not be processed until ALL required documents have been submitted.
Please upload documents demonstrating your annual income. This can be a social security letter, tax documents, etc.*

Cancelof
Please upload proof of residency, this can be a utility bill or other document showing your mailing address*

Cancelof
Release of Information
AUTHORITY FOR RELEASE OF INFORMATION: By signing below, I agree to participate in the Emergency Services Network and utilize the City of Mesa as my primary service agency. I authorize the City of Mesa and/or delegate agency to contact any source necessary to establish the accuracy of the information given by me and to release or receive information contained on this form and/or in my case file.

APPLICANT’S STATEMENT OF TRUTH: Under Penalty of perjury and acknowledged by my signature below, I SWEAR or affirm that the statement made regarding the persons in my home, and the income, resources, property and all other items that pertain to my possible eligibility for benefits are TRUE and CORRECT to the best of my knowledge.
Applican Name:*

First NameLast Name
Date*

MonthDayYear
Signature Date
Applicant/Landlord Signature:*

Clear
Fee Assistance program made possible by the City of Mesa/MesaArts Center.

For questions or if you need help filling out the application, please call (480) 644-6500 or email ArtStudioClass@mesaartscenter.com
City of Mesa | Arts Center| 480-644-6500 | Website

Applicant Information

Household Information

Upload Required Documents

Release of Information

STAFF USE ONLY