Financial Assistance

Programs Offered

2021 Every Penny Counts Application Package

Open this form online and type your responses; when complete save the file to your desktop and email it or print it out and fax or mail it.

2021 Greater Minnesota Every Penny Counts Application Package

Open this form online and type your responses; when complete save the file to your desktop and email it or print it out and fax or mail it.

HOPWA Application Package

This form must be printed, filled out and faxed or mailed

Rental Form

Open this form online and type your responses; when complete save the file to your desktop and email it or print it out and fax or mail it.

Drug Co-pay Reimbursement Program

This form must be printed, filled out and faxed or mailed

Instructions

Please return these forms in person, by mail, or by fax to:

Rainbow Health
2577 Territorial Road
St. Paul, MN 55114

Fax: 612-341-4057

Contact Us

In order to serve our clients, we are required to collect some information to determine eligibility. If you are interested in Every Penny Counts Emergency Financial Assistance, please complete and return the forms below. You can also request an application packet by calling 612–331–7733 or 800–565–9028.

AIDSLine

The Minnesota AIDSLine is Minnesota’s statewide information and referral service that can answer your questions about HIV and link you to help. You can reach the AIDSLine at 612-373-2437; email: aidsline@rainbowhealth.org; or text AIDSLine to 839863.