Fee Assistance Application Form

First Name

Last Name

Address

City

State

ZIP Code

Country

Phone

Number of people living in your household full-time

Annual Gross Household Income

Enter numbers only - no currency symbols, please.

Please provide a personal statement of at least 100 words describing what lifelong learning means to you, your financial situation and how you would benefit from an OLLI membership

By submitting this application, I certify that my current financial situation is accurately reflected above and that I would be unable to participate in the OLLI program without the benefit of the fee assistance program.