Site: ____________________ Grant: __________________ IDA Pre-Application Form I would like to apply to become a Participant in (Agency’s) IDA Program. Name: ________________________________________________________________________ Address: _____________________________________________________________________________ Phone (Daytime): ______________ (Evening): ______________ (Cell): _____________ (Please circle one): Family Information: Gender: Male Female Marital Status: Married Single Separated Divorced Widowed Number of Dependents: ______ You must meet income eligibility and other requirements to be accepted into the IDA Program. IDA Program Staff will make the final determination as to whether you are eligible for the Program. A member of the IDA Program Staff will call you shortly to set up an appointment. Thank you for your interest in (Agency’s Name) IDA Program. Site: ____________________
Site: ____________________ Grant: __________________ IDA Pre-Application Form I would like to apply to become a Participant in (Agency’s) IDA Program. Name: Address: Phone (Daytime): ______________ (Evening): ______________ (Cell): _____________ Family Information: (Please circle one): Gender: Male Female Marital Status: Married Single Separated Divorced Widowed Number of Dependents: ______ You must meet income eligibility and other requirements to be accepted into the IDA Program. IDA Program Staff will make the final determination as to whether you are eligible for the Program. A member of the IDA Program Staff will call you shortly to set up an appointment. Thank you for your interest in (Agency’s Name) IDA Program. Site: ____________________ ________________________________________________________________________ _____________________________________________________________________________
Policies%20and%20Procedures%20Manual%206-29-17%20(hyperlink%20update).docx