Apply For Aid

Here is where we can give all of the instructions for the application.

Email
sleeptightfnd@gmail.com

Phone
620.222.0027

Printable Application

Disclaimer: The information gathered here is confidential and for purposes of determining the fee for services. We will also screen for other possible resources to assist in the treatment of your home.

Name

First Name

Last Name

Age

Date

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date Of Birth

Places of Employment for all in home.

Household Annual Income

Children's Names and Age

Are your children in school or daycare?

If Yes, where?

How long have you been a resident of the property?

Are you the property owner?

If not, who owns the property?

Please provide owner name, phone and email.

Have you informed the property owner of the infestation problem?

If yes, what was the owners response?

Please also include the areas of the infested property that is needing treatment.

Date you first noticed the problem?

What is the source of the infestation?

Have you sought professional pest control treatment of the infestation?

If yes, from whom did you seek treatment?

What treatment was provided?

Do you receive services through HCBS Waiver?

Describe the reason you believe you are a good candidate for financial assistance from the Sleep Tight Foundation, Inc.

How much are you able to contribute to the cost of treatment involved at your location? Will you be able to pay 20%

Proof of income must be provided. Please include at least one of, or all of the following that apply. Select which document will be provided with this application?

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Apply For Aid

Sleep Tight Foundation, Inc.

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