If you are in need, please take the time to explain the situation you are facing so that we can make the best decision as to the help we may be able to provide.

Please enter all of the information in the below form and attach the first page of your most recent 1040 tax return in order to complete your application for assistance. In addition, please attach any photos that may be helpful. All submissions and documentation shared with us will be used solely for the purpose of making a determination as to whether we can assist you or not and to what extent. All information you submit will be kept under strict confidence.

Thank you for your interest in our program.

Disclaimer: By filing this application, you are authorizing HCO to evaluate my actual need for a grant. You understand and agree that the evaluation will include a financial review of your net worth (i.e., payroll information, tax returns, bank statements, etc.) and may also include interviews and a home visit. You certify that you have answered all of the questions on this application truthfully. You understand and agree that if you have not answered the questions truthfully, your application may be denied, and that even if you have already been selected to receive a grant, you may be disqualified from the program and forfeit any rights or claims to a grant. The original or a copy of this application will be retained by HCO even if the application is not approved. You understand and agree that you will not receive this application back nor or any of the documentation you submit with it. You also understand agree that HCO screens all applicants, which screening may include background checks and related searches. By completing this application, you consent to HCO conducting such searches and inquiry. By submitting this application, you are consenting to HCO’s policies and procedures, and to receiving HCO’s email communications regarding this application.