CCA LEAP Application

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Request for Assistance

If you have already applied for financial assistance through SMILE Community Action Agency, you must continue the application process with them. Applications originally submitted to SMILE will not be processed by Catholic Charities of Acadiana.

While completing this form, if you have any questions, please complete as much as you can and we will contact you using the email address you provide.

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

Documents you will need:
Copy of a valid ID
Copy of Landlord Invoice and Landlord W9. Click to download.
Copy of your lease
Copy of Utility Bill for each month for which you are requesting payment
Copy of insurance cards for children and/or all dependents
Copy of an eviction notice
Income Source Documents for all adult members of your household:

4 Consecutive Pay Stubs or a Signed Letter on Employer Letterhead
Award Letter for Unemployment/Bank Statement Showing Deposit
Social Security/SSI/SSDI Award Letters
Self-Attestation of Income/No Income

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. You also are agreeing that you understand that the information contained in your records is confidential. However, you give consent for Catholic Charities of Acadiana to release this information to SMILE CAA, LCG, LA Housing Corporation and the US Treasury Department for the purpose of statistical research.
You attest that your household has experienced a COVID-19 related reduction in income.

This is not a guarantee of assistance.

I agreeI do not agree

Grievance Procedure

When participants of the Catholic Charities of Acadiana, Inc. have a grievance concerning a staff member(s) involved in the services and/or housing they are receiving, they may request a meeting with the staff member’s immediate supervisor. If the supervisor is unavailable and/or the grievance is not resolved, the participant will be referred to the individual listed below.

Kimberly James Boudreaux

Chief Executive Officer

P.O. Box 3177

Lafayette, LA 70502

337.235.4972

Catholic Charities of Acadiana, Inc. will make every effort to ensure that all participants are aware of and understand the grievance procedure upon receiving service and/or housing from this agency.

All complaints and concerns voiced by participants will be treated with respect, and will be handled fairly and justly, with no retaliation toward any participant making a complaint.

By proceeding with this application I acknowledge that I have been made aware of and understand the grievance procedure for participants of Catholic Charities of Acadiana, Inc.

Screening Questions

How many total household members including yourself?

Total 2020 annual household income

Are you currently unemployed?

How many months have you been unemployed?

Total Amount of Assistance Requested, please add rental and utility assistance together.

Applicant Contact Details

The applicant must be the leasee and/or primary person on utility bill.

Contact Details

First Name

Last Name

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

Date of Birth

Gender

Race

Ethnicity

Veteran Status

Phone

Type of Dwelling

Number of Bedrooms

Physical Address Line 1

Physical Address Line 2

City

State

Postal Code

If your mailing address is different please check below.

Yes, it is different

Mailing Address Line 1

Mailing Address Line 2

Mailing City

Mailing State

Mailing Postal Code

Additional Household Members

Is there another 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

Relationship to head of household

First Name

Last Name

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

Date of Birth

Gender

Race

Ethnicity

Veteran Status

Phone

Upload Documents

Upload Valid ID

Upload Income Verification Document

Upload Lease

Upload Utility Bill Document

Upload Landlord W9 Document

Upload Landlord Invoice Document

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