Application Form for Everett Community Care Fund
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Name/Nom *
Address/Adresse *
Phone *
Email/Courriel *
How many people in your family/Combien de meembres dans votre famille? *
Relief requested / Soutien demande: *
Have you received assistance from other organizations in Everett or elsewhere to pay for rent or any other utilities/Avez-vous reçu de l’aide d’autres organisations à Everett ou ailleurs pour payer le loyer ou tout autre service publics *
I have received relief $______ from EHCC/J’ai reçu un soulagement ______ de l’EHCC *
Date *
Signature *
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