Application for Assistance

Applicant’s Name:  _________________________________

                                                                                                                (Please Print)

          Street Address:      ________________________________________________

                                      ________________________________________________

          Phone:                   _____________________________________AM / PM

          Cell:                       _____________________________________

          Description of Need:

          ________________________________________________________________          ________________________________________________________________

          ________________________________________________________________

          ________________________________________________________________

          ________________________________________________________________

          ________________________________________________________________

Name of Person Completing Form:  __________________________________

                                                                               (If Other Than Applicant Above)

                Phone:                   ________________________________________________

          IMPORTANT:  PLEASE READ

While Together for Lincoln will make every effort to provide assistance for all those who request and need it, we can not guarantee that all requests will be able to be filled.

You will be contacted when the decision has been made regarding your project.

Return this form to:  _______________________________________________

                                 _______________________________________________

Application Deadlines:  1. For construction requests, return application

                                             before:  July 1, 2008.

                               2. For all other project requests, return application                                         before: August 15, 2008.