By signing this form, I am stating that the information provided is true to the best of my knowledge, and I understand that by giving false information that I could be prosecuted for fraud.
I understand this is an application for assistance and not a guarantee of assistance.
The information provided will be used to determine program eligibility based upon guidelines set by the programs. I will work with MAHUBE-OTWA if any information is missing. I understand that information must be turned in within 2 weeks of being requested or my application could be denied.
I understand that financial assistance cannot be paid to family members or to me individually, only to a third-party vendor such as my landlord.
If I do not cooperate with MAHUBE-OTWA my application/assistance could be denied or ended.
I agree to a follow-up survey.
If I am assigned a family coach, I agree to work towards a permanent housing plan which means a minimum of once-a-month face-to-face meetings. The family coach can assist with goal setting, budgeting, advocating for my household, resources and referrals to other agencies and other activities related to housing stability.
I understand that assistance is to help me become self-sufficient with my housing.
I understand that if I do not cooperate with my family coach; that termination of housing assistance could happen.
I am agreeing to being added to coordinated entry in the Minnesota State Homeless Information Management System and a copy of this application serves as my receipt.