Next Steps Developmental Consulting · Denver, CO

Sliding scale application

Our hourly rate is set by household income and household size, so families pay what fits their circumstances. We don't ask for pay stubs or tax returns — you tell us your income and we take it at face value. Fill this out, check the rate it gives you, then send it to us. This will take about three minutes.

Your family

So we know who this application belongs to.

Parent or guardian name

Child's name

Child's date of birth

Phone

County

Household and income

Everything here stays in your file and is used only to set your rate.

Household size

Everyone living in the home, including your child.

Gross annual household income

Before taxes, all earners, all sources.

Out-of-pocket medical or therapy costs per year

Subtracted from your income before we calculate your rate.

Child support or alimony you pay per year

Amounts you pay out, not amounts you receive.

Does your household receive any of these?

Services you're looking for

A starting point. We'll adjust together after the first visit.

Type of support

How you'd like to meet

Hours per week you expect

How did you hear about us?

If someone referred you, tell us who in the box below.

Anything you'd like us to know

Your rate

Enter your household size and income above.

Confirm and send

No pay stubs, no tax returns. We take your word for it.

Your name

Date

Two ways to get this to us. Pick either one.

Send it straight from here

Press Send to our office below. Your email app opens with all your answers already filled in and our address already in the To line. Press send in your email app and you're done.

Save a PDF and email it yourself

Press Save as PDF below and save the file to your device. Then start a new email to , attach the PDF, and send it.

Either way works the same on a phone or a computer. If the first option doesn't open your email app, use the second.