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POP's Passion Emergency Assistance Application
UWCC Funding Year 2023 - Applicants must be members of the Lakeview Community
How are you connected to the Lakeview Community?
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Community Resident
Faith Memorial Church Member
No Connection
Other
Applicant's Information
This section is required.
Applicant's Name
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First Name
Last Name
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Date of Birth
*
-
Month
-
Day
Year
Date
Gender
*
Please Select
Male
Female
N/A
Are you of Hispanic, Latino, or Spanish origin?
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No
Yes
Regardless of how you answered the last question, please indicate how you identify your race. (Select as many as apply.)
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American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino descent (Cuban, Mexican, Puerto Rican, South or Central American or other Spanish culture)
White
Other
What is your age?
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18 to 24 years
25 to 34 years
35 to 44 years
45 to 54 years
55 to 64 years
Age 65 or older
What is the highest degree or level of education you have completed?
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Less than high school
High School graduate (includes equivalency)
Some College, no degree
Associate's degree
Bachelor's degree
PH.D.
Graduate or professional degree
What was your total combined household income before taxes the past 12 months?
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Less than $25,000
$25,000 to $34,000
$35,000 to $49,999
$50,000 to $74,999
$75,000 to $99,999
$100,000 to $149,000
$150,000 to $199,999
$200,000 or more
Assistance Request
This section is required.
Have you applied for assistance from another company/organization? If yes, please list the company/organization and the result of the application.
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Have you applied for assistance from POP's Passion Emergency Assistance Fund before?
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No
Yes
If you have received previous assistance from POP's Passion please list the request and application result. If this your first time, please enter N/A.
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Please select your type of request, if not listed please list in the other option.
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Rent
Utility Bill
Transportation for Employment
Job Interview Readiness
Other
If this request applies to Rent or Utility Bill, indicate current status of payment due.
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Past Due
Disconnection Notice
Eviction Notice
Does not apply to Rent or Utility Bill
Other
If this request applies to Transportation for Employment or Job Interview Readiness list current or potential employer.
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Does not apply to Transportation for Employment or Job Interview Readiness
Other
Please enter the amount of the request.
*
Request over $500 may be subject to further review.
Describe the request specifically, provide details.
*
The Emergency Assistance Fund is designed to help with one's basic needs of keeping and maintain a home (shelter).
Upload Supporting Document (Bill or Proof of Employment)
Browse Files
Cancel
of
Applicant Statement
This section is required.
Base upon your interaction today please describe how you felt about the POP's Passion Emergency Assistance application process.
*
Not Satisfied
Somewhat Satisfied
Satisfied
Very Satisfied
Service Quality
Ease of Use
Responsiveness
Friendliness
If POP's Passion Emergency Assistance is awarded, please describe how this will allow for you to keep or maintain your home (shelter) and basic needs.
*
Do you believe POP's Passion Emergency Assistance provides "Upward Mobility" for the community of Lakeview?
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Yes
No
From 1 (lowest) to 5 (highest) indicate how likely you are to recommend POP's Passion Emergency Assistance to friends or family.
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1
2
3
4
5
Not Likely To Recommend
Highly Recommend
1 is Not Likely To Recommend, 5 is Highly Recommend
Applicant Confirmation of Application
This section is required.
All applications are subject to approval. This place based Lakeview Community program has limited funds. Funds will be awarded monthly until program funds are depleted. If awarded, payment will go directly to the listed entity (company/organization) in the request. Denials may include but are not limited to not living in the Lakeview Community, request doesn't support the basic needs initiative, and or monthly funds are depleted. Program Funds are refresh monthly for a 12 month cycle. This fund is designed to bring Upward Mobility to the Lakeview Community. We will contact you within 24 hours to update you on your application.
Blessings, POP's Passion website: www.popspassion.com email: popspassion@mail.com
Date of Application
*
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Month
-
Day
Year
Date
Signature
*
Submit
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