Application for Assistance
Emergency Assistance During the COVID-19 Crisis
Email address *
Name *
Your answer
Physical Address (Include City, State, and Zip Code) *
Your answer
What county do you live in? *
Telephone Number You Can Be Reached *
Your answer
What is the best way to contact you? *
Do you consent to a representative of The Gathering to contact you as a result of this application? *
How Many Adults Live In Your Household? *
How many children live in your household? (You must have a child under the age of 18 living in your residence full-time to qualify for assistance) *
What is the Ethnicity of the Head of Household? *
What is your employment status as of the date of this application? *
How will the payment of rent or utilities (One Per Household) impact your family? (This answer needs to be at least 1 paragraph in length) *
Your answer
Are you available to sign for this assistance, if you are chosen? *
Do you consent for a representative of The Gathering to speak to the landlord, rental agency, or utility company in regard to your account? *
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