Cornerstone NCT Assistance Request
Name
*
First Name
Last Name
Physical Address (*please note the boundaries of our current service area - North of Hwy 121, South of FM-121, West of I-75 and East of 377)
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
example@example.com
Phone Number
*
Please enter a valid phone number.
Have you previously participated in any Cornerstone program(s)?
*
YES
NO
How can we assist? (We do not assist with rent or medical bills) **PLEASE NOTE THAT AS OF 5-15-22, ALL GRANT FUNDING FOR RENTAL ASSISTANCE HAS BEEN EXHAUSTED AND WE ARE NO LONGER ABLE TO ASSIST WITH RENT**
*
Submission of this form does not guarantee assistance. You will be contacted for additional information to determine your eligibility for assistance.
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