Helena Adult Art Education Fund
Reduced Adult Class Fees Schedule and Guidelines

To apply for 50% reduced adult class fees, print, complete the form and mail with your reduced fee amount to the: Range Creative Art Center - 328 W Howard St - Hibbing, MN 55746

Name: ___________________________________ Phone: _________________

Address: ________________________________________________________

_______________________________________________________________

Total number in household: _________ Total monthly income: $______________

Class description: ____________________________ Reduced fee: $_____________

Add the total of all adult household monthly gross income, including: earnings from work; social security; retirement; unemployment; workers compensation; public assistance; child support; spousal maintenance; interest from savings, bonds, investments; self-employment or seasonal income.

If the total of all gross income is at or below the levels in the chart below, you will qualify for reduced fees of 50% per class.  Reduced fees are not allowed for "Kids Summer Art Camp" and "Otherwise Specified" Classes or extra materials needed for any class.

1  in Household     -     $1325  per month
2  in Household     -     $1790  per month
3  in Household     -     $2256  per month
4  in Household     -     $2722  per month
5  in Household     -     $3187  per month
6  in Household     -     $3653  per month
7  in Household     -     $4118  per month
8  in Household     -     $4584  per month
Add $466 for each additional household member

All information submitted to the Range Artists Association Inc. will only be used for determining reduced class fees and will not be released to any other party. A completed and signed form must accompany each class that reduced fees are requested for.  Any questions, please call 1-218-263-6785 and leave a message.

Signed: _________________________________ Date: _____________

By signing this form I certify that all income is correctly stated and I understand that any intentional deception will result in my losing the opportunity for reduced adult class fees for two calendar years.