• Application for Assistance

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  • All applicants must complete an interview with a caseworker before determination of assistance can be made. All assistance requires processing time. Applications are active for 10 business days. Determination of assistance is conducted on a case by case basis that includes documentation and assessment information.

    If unable to be seen in-office, applicant may request a telephone interview.  It is the client’s responsibility to call and schedule the telephone interview.


    Documentation must be provided.

  • Briefly explain your crisis:


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  • Code of Conduct Agreement

    To ensure a cooperative, safe, and courteous environment, a Code of Conduct will be enforced by the Cheyenne and Arapaho HOPE Program. HOPE is focused on providing the client with caring and respectful service, making every
    attempt to avoid any physical or emotional damage to either clients or staff. Please adhere to the following standards.


    • Any inappropriate use of language is disrespectful or will not be tolerated.


    • Threatening/intimidating remarks about the staff to other clients are also disrespectful and will not be
    tolerated.


    • Inappropriate behavior such as throwing objects, violent physical contact with others in the office, or
    raising a voice in anger or contempt will not be tolerated.


    • The staff will use respectful and professional behaviors with a client and anticipate the same behavior
    from the client.


    HOPE understands the difficulties of going through a crisis and will make every effort to make the application
    process go quickly and smoothly. Please exhibit patience and understanding with the extensive application
    process and be informed there are consequences for any inappropriate behavior

  • Supporting Documentation

  • Please attach necessary documentation described below.  If any bill or lease provided is not in your name, you will need to fill out and also attach the Residence Verification Form, which is found by clicking here.

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  • Acknowledgement of Two Time Assistance Form

  • If you have not done so already please download the Acknowledgement of Two Time Assistance form here:  https://cheyenneandarapaho-nsn.gov/wp-content/uploads/2018/10/twotimeassistance.pdf

    This requires your caseworkers signature.  Upload the completed form below.

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  • AUTHORIZATION FOR RELEASE OF INFORMATION

  • I hereby authorize you to release any information from any medical facility, institutions, the Social Security Administration, any local, State, or Federal Law Enforcement Agency, or any other agency. I understand that his information is to be held confidential by all parties.

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  • The information is to be released from:

  • This authorization will terminate one year from the date of my signature. It is further understood that I may revoke this authorization any time by written request except to the extent that action has been taken in reliance theron.

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