Our Lady of Perpetual Help Catholic Church
7655A E Main Street, Scottsdale, AZ 85251
Agency determining assistance:
Society of St. Vincent de Paul
Customer Consent Form Language:
I hereby consent to and authorize The Society of St. Vincent de Paul ("Agency") to access any financial information from any related credit, bank, or other lender accounts concerning payment history, delinquencies, outstanding amounts owed, required deposits, usage history and other related information, and to use such information in connection with my application for financial assistance on this date. This consent and authorization shall expire following Agency's review of my information for qualification of financial assistance on this date.
Statement of Truth:
Under penalty of perjury and acknowledgement by my signature below, I swear or affirm that the statements made regarding the persons in my home and the income, resources, property and all other items that pertain to my possible eligibility for benefits are true and correct to the best of my knowledge.
Applicant Signature
As indicated by my signature below, I solemnly swear, under penalty of perjury, that the statements regarding my eligibility for services and benefits, along with my submitted documentation, are true and correct to the best of my knowledge.
Thank you!
Your Signature
CURRENT LEASE AGREEMENT
Must be signed by Landlord and Tenant
Lease must include at least the 1st and last pages
Applicant MUST be listed on the lease
PROOF OF CRISIS - only ONE of the following is needed, relating to ANY family Member:
Termination letter from Employer
Application for benefits
Employer letter of reduced work hours
Unemployment letter/SSI benefits discontinued
COVID-19 related treatment costs or medical bill
COVID-19 related FMLA paperwork
Receipts of any unexpected expenses
Child Care costs related to COVID-19
IDENTIFICATION (one of the following is needed):
Driver's License or State Issued I.D.
ID Card from Health Benefits or Social Services program
Social Security Cards
Voter Registration Card
INSTRUCTIONS: Please be sure to submit COMPLETED APPLICATION and DOCUMENTS. Our Office will contact you only if copies of ALL DOCUMENTS are submitted. Due to high volumes of applications, we are not able to accept calls regarding application status.
PLEASE PROVIDE SUPPORTING FILES FOR IDENTIFICATION, LEASE, AND CRISIS: