2021-09-15 ARPA Attestation Form (Georgia Gunter)

ARPA ATTESTATION FORM

American Rescue Plan Act (ARPA) Funding through Fulton County,
administered by Jewish Family & Career Services, subgrantee

Client Full Name

I am a client of Jewish Family & Career Services (JF&CS), and I agree to the services listed below based on an assessment and service plan developed with JF&CS staff.

Staff member name

Date of assessment

Date

I acknowledge the services I am receiving are funded by the American Recovery Plan Act, managed by Fulton County, and facilitated by JF&CS.

My signature is an attestation that to the best of my knowledge, I have not received financial assistance funded by ARPA funds from another agency during the funding period from March 17, 2021, to December 31, 2021.

Signature

Clear

Date of signing

Date

Service(s) Received (please list)

JF&CS is a proud partner of the Jewish Federation of Greater Atlanta and the United Way of Greater Atlanta. Accredited by the Commission on Accreditation of Rehabilitation Facilities.