Project Footprints Referral Form

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Project Footprints Mission is to serve individuals and families in our community impacted by emergency situations. Requests are processed on a first come, first serve basis within the constraints of our budget and established criteria.
Project Footprints support is typically under $400; higher amounts will be considered on a limited basis.
Please provide complete information so the board can accurately consider your request.
All information is confidential between applicant, referral, and Project Footprints.

A referral from a trusted source can greatly assist the Project Footprints board when reviewing and approving
applications. As a referring source, please complete the supporting information below to the best of your knowledge.

(This form MAY NOT be filled out by the applicant. Link to online application can be found here:

Email *

Referral Agency/Name *

Phone Number *

Address *

Name of Applicant *

How long have you known applicant? *

Application has already been submitted to Project Footprints. (It is acceptable to continue with the application, if the answer is no.) *

Yes

Not Sure

What other agencies (if any) have you referred the applicant for assistance? *

In your opinion, what is needed to resolve the situation? *

Please list priority of funds requested. 1 being top priority, followed by 2, etc: *

Payment should be made to: *

I have verified the details and needs described in the application. *

Yes

Send me a copy of my responses.

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