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Immigrant Relief Fund
Request for Assistance
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* Indicates required question
Email
*
Your email
Date
*
MM
/
DD
/
YYYY
Advocate making the request (Name/Phone)
*
Your answer
Applicant's Surname & Phone
*
Your answer
Immigration Status
*
DACA
Undocumented
Asylee/Refugee
Temporary Protected Status (TPS)
Other:
Required
Number of people being served by the request (Adults/Children under 18)
*
Your answer
County of person(s) served
*
Hood River
Wasco
Klickitat
Skamania
Description of the Need
*
Your answer
Dollar amount requested
*
Your answer
Do you have this need because of COVID?
*
No
Yes
By what date do you need assistance? What is your deadline?
*
MM
/
DD
/
YYYY
Is it possible to pay the expense directly?
*
Yes
No
Maybe
If so, to whom would the payment be made?
Your answer
Do you know the applicant and believe that providing cash assistance is appropriate?
*
No
Yes
Other:
If yes, please explain.
Your answer
Any additional comments or questions?
Your answer
Important Note: Once you have completed this form, please text Andy Wade to let him know a new request has been submitted. 541-806-5415
Send me a copy of my responses.
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