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HEALTHCARE FINANCIAL ASSISTANCE SCHOLARSHIP

Healthy Asians & Pacific Islanders Medical Center staff is able to enroll you in the Healthcare Financial Assistance Scholarship Program with Asian Community Development Council.

Asian Community Development Council’s Healthcare Financial Assistance Scholarship Program’s goal is to help alleviate financial burdens by offsetting any healthcare related costs per individual who receives consults or treatments at Health Asians & Pacific Islanders Medical Center. Such scholarships may consist of either full or partial payment of the patient’s financial obligation, offering a self-pay sliding scale discount, to be determined on a case by case basis. If approved, your enrollment for the scholarship will last for ONE YEAR ONLY and is non-renewable and non-transferable.

Asian Community Development Council Healthcare Financial Assistance Scholarship Program is NOT an insurance plan. Asian Community Development Council does NOT provide health insurance coverage under the Federal Health Insurance Marketplace Exchange.

For more information or to make an appointment to apply, contact HAPI Medical Center at 702-485-3888. Please bring the required following documents to your appointment.

PROOF OF IDENTITY:

Picture Identification: Please provide one (1) unexpired of the following documents:

●  State-issued driver license

●  State-issued ID card

●  Current student ID

●  Current employee job badge

●  U.S. Immigration documents

●  Passport with picture

●  Foreign consulate ID card

Other Identification: If you do not have any of the above-listed forms of picture identification, please provide two (2) of the following documents:

●  Birth certificate

●  Marriage license or Declaration and Registration of Informal Marriage

●  Hospital or birth records

●  Adoption papers or records

●  Current pay check stubs

●  Social Security card

●  Other federal document showing your name and current address

PROOF OF INCOME:

Please provide all of the following documents that are applicable to you:

●  The past 30 days pay check stubs or 3 consecutive pay check stubs

●  Proof of 3 consecutive months bank statements

●  Proof of cash income

●  Proof of income from rental property

●  Workmen's compensation

●  Proof of dividends and/or royalties

●  Proof of alimony received

●  Proof of military pay and/or allowances

●  Child support documents

●  Social Security award letter

●  Retirement award letter

●  Current IRS 1040 tax return (all pages) including self-employed

●  Veteran Affairs letter or 3 consecutive pay checks

●  Unemployment benefits record

●  SNAP award letter

PROOF OF RESIDENCY:

Please provide two (2) of the following documents dated within the last 60 days:

●  Utility bill (NV Energy, Southwest Gas, and/or Water)

●  Mortgage coupon

●  Rental Lease Agreement

●  Credit card statement

●  Certification paper from Supplemental Nutrition Assistance Program (SNAP)

●  Property tax document

●  DMV registration

●  Automobile insurance document

●  Automobile registration

●  Printout from IRS of most current year's tax filing

FAQ:

Q1. Can I use my scholarship at other clinics or health centers?
A. No, this scholarship program only applies to HAPI Medical Center.

Q2. What’s covered in the scholarship program?
A. Prescription, Labs and Imaging, and Office Visits.

Q3. What is the duration of my scholarship?
A. One year from the approval date and/or when the funds are depleted, whichever comes first.

Q4. Can my scholarship be terminated or end early?
A. It varies case-by-case. For example, if you have health insurance through work, family

members, or yourself.

Q5. Who can use my scholarship benefits?

A. Only the approved applicant.

Q6. Is my scholarship benefit transferable?
A. No, it is not transferable and not renewable.

Q7. How long does it take to process my application?

A. It takes up to 48 hours.

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