Housing Assistance Parish Grant Application

- Housing Assistance Parish Grant Application
  
  The maximum number of form submissions has been reached. This form is currently not available.
  
  Date of Application REQUIRED Please fill out this field. Please enter a date.
  
  Parish Information
  
  Parish Name REQUIRED Please fill out this field. Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  County REQUIRED Please fill out this field. Please enter valid data.
  
  Parish Office Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Pastor Info
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Pastor Email REQUIRED Please fill out this field. Please enter an email address.
  
  Program Information
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Project Coordinator Email REQUIRED Please fill out this field. Please enter an email address.
  
  Project Coordinator Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Name of Program Please enter valid data.
  
  Application Questions
  
  On Average, how many people does your emergency housing program serve per month? REQUIRED Please fill out this field. Please enter an integer (number).
  
  Does your community offer programs to serve emergency housing needs? REQUIRED Please fill out this field.
  
  On Average, how many people are served by the community program per month?
  Leave field blank if you selected "No" on the previous question
  Please enter an integer (number).
  
  On average, how many people come to your parish requesting emergency housing assistance per month? REQUIRED Please fill out this field. Please enter an integer (number).
  
  What are the average age ranges of people looking for assistance? REQUIRED Please fill out this field. Please enter valid data.
  
  In what ways are you serving people with your program? REQUIRED Please fill out this field.
  
  Are you able to adequately serve the people who come requesting services? REQUIRED Please fill out this field.
  
  What is the amount your parish is requesting? REQUIRED
  The average grant range will be between $500-$1,000.
  Please fill out this field. Please enter valid data.
  
  By selecting "I Agree" you are certifying that you agree to the following requirements:
  
  1. Received permission from your parish pastor to apply for the Emergency Assistance Parish Grant.
  
  2. Agree to submit a final report if your program is approved for grant funds.
  I Agree Please select this field.
  
  Submit
  
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