Steiner Health Financial Aid Program

As part of our charitable mission we encourage patients with a true need for financial support to communicate that to us by filling out the information on this form.  We also need a copy of your current or last year’s tax return [1040] (if you are a dependent then the head of household’s tax return is needed).  We have very limited resources for financial assistance. Please ask friends and family members who have your best interests in their heart to help cover the cost of your stay.  Include their pledges on this form.  Please note that financial aid is only awarded towards shared room registrations.

We will evaluate your situation and request and take into consideration all other requests for the session you are interested in attending.  Please send us this information as soon as possible so we can consider all financial requests in a timely manner.  

Criteria for determining aid:

Family income verification

Number of people in applicant’s household

Special circumstances such as outstanding medical bills, loss of job, business loss etc.

Expectations of financial aid recipients:

Timely payment of remaining balance

Retreat participation in its entire length


Please return this application with a signed copy of your latest federal tax return. If there are multiple tax returns for your household, please include a copy of each return. If you have no taxable income, please include a paycheck stub, social security benefits letter(s), or ADC forms. If the payer is in the U.S. on a student or non-working visa, he/she must provide appropriate documentation of this status. Please provide documentation summarizing the amount of support granted to the payer by any other party, such as church, family, friends etc.


  • Date Format: MM slash DD slash YYYY
  • Household Financial Information

    Please list your ADJUSTED GROSS INCOME from your prior year’s income tax return (line 37 on the 1040 or line 4 on the 1040 EZ). If there are multiple tax returns for your household, please combine the adjusted gross incomes from all returns.
  • Drop files here or
    Accepted file types: pdf, jpg, png.
  • Disability? Retirement income? Passive income?
  • An applicant’s financial documentation does not always reflect his or her current fiscal situation. Therefore, please explain any special circumstances your need for financial aid, providing as much detailed information as possible. Exceptional situations might include sudden or prolonged illness, loss of job, business loss, etc.
  • Date Format: MM slash DD slash YYYY

Additional information may be requested if necessary.

If you have questions about the financial aid program, please contact us.