Financial Assistance Application - Washington

Download and Mail

Apply Online

This will generate an email request for the online application.

The online form IS NOT designed to be used on a smart phone. Please use a tablet device or computer to access the form.

Using our online form requires that you attach documents such as income information. Please make sure that these documents are available on the device you use.

Proof of income is required. If you have no income, please attach a letter of explanation.

If you are unable to attach the required documents, please download the paper form and mail it and the required documents to:

PH&S Regional Business Office
P.O. Box 4227
Portland, OR 97208-3395

If you have any questions, please call us at:

(855) 229-6466
Monday - Friday 7:00am-5:30pm PT

We will respond to your request via email within 14 business days of receiving it along with all required documents. Please check your Junk Mail folder if you have trouble receiving email from FinancialAssistanceRequests@providence.org.