Gather Supporting Documents Needed for Application
Payroll check stubs (last three months and most recent check stub showing gross year-to-date earnings), most recent IRS tax return or bank statement
If unemployed, bank statements, Federal tax return, statement of benefits or other unemployment compensation records
If on a government program, notice of benefits
School financial aid award letters and transcripts
Other documents may be required. Please check the Request for Financial Assistance Application for more details.
Step 3
Complete and Return Application
Complete and return the Application for Financial Assistance along with the required supporting documents within 10 days from receipt of your billing statement.
All information relating to the application will remain confidential. Additional information may be required.
Submit Application and Supporting Documents to:
Samaritan Health Services Regional Business Office PO Box 1188 Corvallis, or 97339-1188
