Pre-Screening Questionnaire

1 (Dwelling that the Household Applicant(s) resides in for a minimum of 182 days or more per calendar year) 
2 Having a direct or indirect COVID-19 impact may look like:
  • Having qualified for unemployment benefits
  • Having experienced a reduction in household income
  • Having incurred additional costs due, directly or indirectly, to the COVID-19 outbreak
  • Having experienced other financial hardship due, directly or indirectly, to COVID-19
  • Losing a job or having hours reduced
  • Losing access to childcare or dependent care

Please help us verify that you are under the income limits of the program:

3 The total gross income for all household members aged 18 and over. Total gross income does not include public benefits such as Supplemental Nutrition Assistance Program benefits.