Assistance Application
Required fields are marked
*
. Some questions appear based on your answers.
Applicant
Full Name
*
ZIP Code
*
* Housing (Choose One) (required)
I rent my home
I own my home
Landlord or property manager name
*
Monthly rent (whole dollars)
Mortgage lender
Referral
How did you hear about Harvest Hill?
Select one
My child's school
Another agency
Faith community
Other
Please specify
*
Children
There are children under 18 in my household
How many children?
School district
Submit Application