Project Footprints Referral

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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. We prioritize assistance for individuals experiencing a recent, unforeseen crisis, who demonstrate ongoing efforts to regain stability. Project Footprints support is typically under $500; 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 professional 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.)

Email *

Referral Contact Information

First & Last Name *

Phone Number *

Street Address *

City *

Professional Affiliation *

Applicant Information

Name of Applicant *

How long have you known applicant?
*

Emergency and Support Needed

An emergency is an unexpected, sudden, and short-term crisis that threatens an individual or family's immediate health, safety, or stability.

What is the applicant's emergency situation? *

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

What other agencies, if any, have you referred the applicant to for assistance? *

First priority of funds should be:
*

Second priority for funds should be:

Payment should be made to: *

If approved and funds need to be mailed, what is the full mailing address?

Please Certify *

I have verified the details and needs described in the application. All information in this form has been provided by me, and is true to the best of my knowledge.

Required

A copy of your responses will be emailed to the address you provided.

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