MSC Financial Assistance Application

Msgr Sigur Center Financial Assistance Application

If you are in need of financial assistance such as utilities, or other supports, please complete the form below. It is important to answer each question so that we can better serve you.

Documents you may need:
Copy of a valid ID
Copy of your lease
Copy of your utility bill
Copy of insurance cards for children and/or all dependents
Copy of an eviction notice
Income Source Documents

4 Consecutive Pay Stubs or a Signed Letter on Employer Letterhead
Social Security/SSI/SSDI Award Letter
Most Recent Tax Return

Should we need additional information a service coordinator will contact you at the number provided in your application. Submitting an application does not guarantee assistance.

By checking the button below you are agreeing to participate in Catholic Charities of Acadiana's Financial Assistance Program, that all information included is true, and that you will provide additional information if requested. This is not a guarantee of assistance.

I agreeI do not agree

Type of Assistance Needed

Funeral AssistanceUtility AssistanceOther

Applicant Information

Contact Details

First Name

Last Name

Email

What are the last four digits of your Social Security #?

Date of Birth

Gender

Race

Ethnicity

Veteran Status

Disabled?

Phone

Copy of Photo ID

Address Information

Physical Address Line 1

Physical Address Line 2

City

State

Postal Code

Property Type

Description of Property Type

Household Information

Including yourself how many household members.

Is there another adult member of your household?

Please select

YesNo

Please select "Add another response" at the bottom of this section for as many adult members as you have in your household.

Household Member Contact Details

First Name

Last Name

What are the last four digits of this person's Social Security #?

Date of Birth

Gender

Race

Ethnicity

Veteran Status

Disabled?

Relationship to Head of Household

Phone

Copy of Photo ID

Copy of Medical Card

Is there a child in your household?

Please select

YesNo

Please select "Add another response" at the bottom of this section for as many children as you have in your household.

Child Contact Details

First Name

Last Name

Date of Birth

What are the last four digits of the child's Social Security #?

Gender

Race

Ethnicity

Disabled?

Relationship to Head of Household

Copy of SSN Card

Copy of Medical Card

Please select "Add another response" if there is another child in your household in order to input their information, otherwise move on to the next section.

Other Financial Assistance

Please tell us the type of assistance you are seeking, an approximate amount, and give a brief explanation.

Type of Assistance

Amount Requested

Brief Explanation

If you have difficulty completing this form, please call 337-235-4972 and press 3. Please leave a message if prompted and someone will call you back.

Utility Assistance

Please tell us the name of the utility company, the amount, and attach a copy of the most current bill.

Utility Company

Amount Requested

Utility Bill

If you have difficulty completing this form, please call 337-235-4972 and press 3. Please leave a message if prompted and someone will call you back.

Brief Explanation of why you are unable to pay your utility bill. Did you have an unexpected expense or loss of income in the last 90 days?

Supporting Documentation for unexpected expense or loss of income.

Funeral Assistance

Information needed to receive Funeral Assistance.

* Copy of Photo ID
* Invoice from Funeral Home

If you have difficulty completing this form, please call 337-235-4972 and press 3. Please leave a message if prompted and someone will call you back.

Copy of Your Photo ID

Invoice from Funeral Home

Submission Page

Please add any additional documentation you have to support your application.

The final step for your application is to hit the submit button below.

Thank you,