Guardian Angel Financial Assistance Program

Today's Date

Please read before filling out the application!

Our Guidelines:
We ONLY ACCEPT applications in zipcodes Allen (75002 & 75013), and Plano (75025).

* Assistance may be considered once every 18 months.
* Photo ID required. (must attach)
* Must attach Main Page of your lease.
* Must attach utility bill(s) if requesting help for utilities.
* Funds are paid directly to the entity owed.
* We will contact the entity owed to verify the debt.
* The application does not guarentee assistance.

Applications must be submitted by 5:00 pm Monday or they will be held until the following week.

Applications submitted on time will receive a phone called on Tuesday morning.

We will call you. If your voicemail is full or we cannot reach you, we will send you an email.

I acknowledge that I have read and understand the above guidelines of the Guardian Angel Financial Assistance Program

Yes No

Personal Information

Name

Your Date of Birth

Gender

Male Female

My Zip Code

75002 75013 75025 Other (will not be considered for assistance at this time)

Help is needed with

Rent or Lease Electric Bill Water Bill Gas Bill

Amount requested?

What is the crisis or situation that has caused you to seek assistance? (Give full details.)

What specific help are you requesting today?

Are you able to contribute to the need yourself? If so, how much are you able to cover?

Home Address (NO P.O. Box)

Apartment Number

This address will receive a confirmation email

Phone

Please mark all that apply to you:

Disabled Single Parent Veteran Retired Other

Proof of Residence

Texas Driver's License Current Utility Bill Photo ID Card Other

Family Information

Spouse Name (if applicable)

Spouse's Date of Birth

Marital Status

Single Married Divorced Separated Widowed

Other Dependents

How many adults? (18 and over)

How many children under 18?

Relationship

Age

Relationship

Age

Relationship

Age

Name

Relationship

Age

Relationship

Age

Housing Information

Housing Information

Rent Own Live w/Family Live w/Friend Homeless Other

How long have you live at your current address?

How much do you pay for housing?

Leasing Information - Some Leasing Office do not accept business checks - It is your responsibility find out.

Name of Apartment Complex

Address of Leasing Office

Contact at Leasing Office

Phone Number of Leasing Office

Contact your leasing office. Do they accept partial payments? This is your responsibility to find out this information. Do not assume they do.

Yes No I am not sure. - Call them!

Eviction Notice: Has the leasing office filed an eviction order? If yes, please attach a copy of that order. Will they accept a business check?

Yes No

Employment Information

Are you employed?

Yes No

Name and address of employer, (If not employed type in N/A)

Is your spouse employed? Yes No

Name of employer

Are others in your household employed? Yes No

If you are not currently employed - Please explain.

Other Sources of Income

Unemployment Disability Income Child Support Social Security Veterans Benefits Other income none

In the last 18 months, have you received assistance from Our Lady of Angels?

Yes No

List other organizations you have applied to in the last 12 months:

Guardian Angel Financial Assistance Release Agreement

I understand and acknowledge that, to the best of my knowledge, the information given is true and up to date, and that Our Lady of Angels may, and has my permission to, verify application information.

Yes No

Our Lady of Angels Catholic Church may contact all persons and organizations for the purpose of verifying the information requested so that I may recieve the requested assistance. All such persons and organizations are hereby authorized to disclose all information regarding me in their possession. I agree to hold Our Lady of Angels Catholic Church Employees and Volunteers; and the Diocese of Dallas harmless with respect to soliciting, documenting, and maintaining such information provided that they exercise reasonable care to insure confidentiality.

I understand and acknowledge that this application does not guarantee help by Our Lady of Angels Catholic Church, Allen.

Yes No

I state that I have CAREFULLY READ THE FORGOING RELEASE AND KNOW THE CONTENTS THEREOF AND I SIGN THIS RELEASE AS MY OWN FREE ACT. This is a legally binding release which I have read and understand.

Yes No

I understand and acknowledge that once a decision has been established by Our Lady of Angels regarding an applicaiton, a waiting period of 18 months commences before an applicant may reapply for financial assistance.

Yes No

Print your full name

Today's date

Upload proof of residence, driver's license or Photo ID.

Upload (8MB)

Upload lease (first page only)

Upload (8MB)

Upload paper copies of your utility bills (DO NOT submit a screenshot of the bill)

Upload (8MB)

Upload paper copies of additional documents (DO NOT submit a screenshot of a bill or document)

Upload (8MB)

Attach extra documents (DO NOT submit a screenshot of a bill or document)

Upload (8MB)

Checklist

Is a copy of your driver's license attached? It is a required item.
Is a copy of your lease attached? We must have the information page.
Are copies of your utility bills attached? (DO NOT attach screenshots of your online reminder to pay sent from your utility company.)

Additional Comments

OFFICE USE ONLY

Volunteer

Date

Status of application

Guardian Angel Financial Assistance Program

Description

Please Fix the Following