Application | INFINITE CREATION FOUNDATION INC

Email*

Name*

Date of Birth*

Gender

Male

Female

Non-Binary

Prefer Not To Say

Social Security Number (Last 4 Digits)

Phone Number

Current Living Situation:

Sheltered (Emergency Shelter)

Unsheltered (Street, Car, etc.)

Doubled Up (Staying with friends/family)

Rental Housing (Facing eviction)

Other:

Which services are you seeking today? (Check all that apply)

Housing & Homelessness Prevention (Rental assistance, security deposits)

Employment Assistance (Resume building, job placement)

Basic Needs Assistance (Food, clothing, transportation)

Workforce Development (Skills training)

Mentoring Program (Personal development & goal setting)

AI & Financial Literacy (Budgeting and technology classes)

Other:

Current Employment Status:

Full-time

Part-time

Unemployed

Disabled

Other

Source of Income:

Wages

SSI/SSDI

TANF

None

Other

Highest Level of Education

Total number of people in household:

Are there minor children in the home?

YES

NO

Are you a Veteran?

Yes

No

Briefly describe your current situation and how Infinite Creations FDN can best support you:

I certify that the information provided above is true and accurate to the best of my knowledge. I understand that this information will be used to determine my eligibility for Infinite Creations FDN programs.

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