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Legacy Harvest Foundation- Financial Assistance Application-2022
1.
Have you experienced a hardship in 2022?
Yes
No
2.
Are you currently employed?
Yes
No
3.
Please provide your zip code in Georgia?
4.
Do you rent a home or an apartment?
Yes
No
5.
Is the place you need assistance with your primary residence?
Yes
No
6.
What is the total number of people who reside in this household?
7.
Have you or individuals in your household qualified for unemployment benefits?
Yes
No
8.
Are you or members or your household experiencing homelessness or housing instability?
If so, have you experienced the following?
*Has received a rental eviction notice.
*Has received past due utility or rent notice(s).
*Experiencing a housing cost burden.
*Forgoing or delaying the purchase of food, prescription meds, childcare, or similar essential necessities.
Yes
No
9.
What type of assistance are you requesting?
Utility Assistance
Housing Assistance
10.
What is your name, email, and phone number?
Current Progress,
0 of 10 answered