Financial Assistance Application
Who is eligible for Financial Assistance? Any household that qualifies under the income level threshold.
How do I apply for the discount? Complete the application below and return it to Citizens for verification.
Do any restrictions apply? Citizens will semi-annually ask you to resubmit your income to confirm that your eligibility is still in effect. If you are no longer eligible, your service will revert to retail pricing.
**Household Income Includes: Wages, Social Security, Disability, Self Employment, Child Support
Children living in the Household:
Please read and sign the following statement: I certify under penalty of perjury that the above information is correct. I understand that willfully making false statements to obtain the benefit can result in penalties, de-enrollment, or being barred from the program. I authorize Citizens to access any records necessary to verify my eligibility for the discount program. I give permission for any agency to release information that will help verify my eligibility in these programs. I understand that if I am no longer eligible, my discount will be discontinued. I acknowledge and consent to Citizens providing my information to the School System for the purpose of verifying student enrollment. This financial assistance is provided directly by Citizens, therefore Citizens reserves the right to change the requirements or end the discount at any time.
*Restrictions Apply. Usage will be monitored, if misused for excessive entertainment purposes, discount will be discontinued. Citizens will provide installation of one outlet in the home (if one does not already exist) with a WiFi-enabled modem. No additional equipment will be required. No contract and no termination fees. Equipment is required to be returned when the service ends. Offer, prices, and eligibility are subject to change. This is not a program provided by the school, therefore no school funds are used. This service is not restricted, parental guidance is recommended. Parental Control/Virus Protection service available upon request.
Service Information:
Floyd area: Payment is due by the 20th of each month, Wythe area: Payment is due by the 30th of each month. Late fees apply. Service will be disconnected after 60 days past due.