About Your Organization
Organization Information
Organization Name
*
Organization Type
*
Please Select
For Profit
Non Profit
Municipality or Government
EIN / Tax ID
*
Website
*
Physical Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Primary Contact Name
*
Title
*
Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Is your organization a customer of Western Security Bank?
*
Yes
No
About Your Organization
Please provide your organization's mission statement
*
If no mission statment type "None"
Please describe the programs and services provided by your organization
*
Please describe the primary populations your organization serves
*
Please describe the geographical areas your organization serves
Low- and Moderate-Income (LMI) Impact
Does your organization primarily serve low-to-moderate income individuals?
*
No
Yes, greater than 50%
How does your organization determine whether individuals are low-or moderate income?
*
HUD income guidelines
Free or Reduced-Price Meal eligibility
Medicaid eligibility
SNAP eligibility (Supplemental Nutrition Assistance Program),
TANF (Temporary Assistance for Needy Families) eligibility
Section 8 / Housing Choice Voucher eligibility
LIHEAP (Low Income Home Energy Assistance Program)
Income verification
Other
Does your organization consider individuals with household incomes at or below 80% of Area Median Income (AMI) to be low-or moderate income?
Yes
No
If "Other" please specify
*
Submittor Information
Name
*
Title
*
Submit
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