SMILE LEAP Application

Request for Assistance

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

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 Click to Download
Copy of 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 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 SMILE'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 SMILE to release this information to CCA, 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

CLIENT GRIEVANCE PROCEDURES

If you believe that you have been treated unfairly or a mistake has been made about your eligibility for services, you have the right to request a review of the matter by a supervisor and/or the SMILE EQUAL OPPORTUNITY OFFICER. This means that you will be given an opportunity to present your side for a review by a person(s) at this agency who will assure that you are treated fairly. Your right to a review applies to any of the following:

1. Any decision by a SMILE Caseworker concerning eligibility or eligibility redetermination for services, or the amount, continuation, termination, or reduction of services.

2. Failure by the SMILE Caseworker to act with reasonable promptness on a request for services.

3. If you believe that you have been discriminated against because of race, color, religion, sex, age, national origin, and/or disabling condition.

The grievance procedure shall be as follows:

Step 1 You (the client) present the grievance to the SMILE Caseworker's supervisor immediately, or as soon as reasonable possible. The supervisor will review the files, and then present an explanation of the reason for the Caseworker's decision.

Step 2 Should you decide that the reply of the immediate supervisor is unsatisfactory, you will be directed to the Program (Department) Director. The Program Director shall make every effort to resolve the complaint informally within two (2) days of the grievance.

Step 3 Should you decide that the reply of the Program Director is unsatisfactory; the matter is presented to the EO Officer for continued attempts at resolution. If the EO Officer cannot resolve the issue to your satisfaction, you will be invited to participate in an informal conference which will be scheduled within five

(5) days of your contact with the EO Officer or as requested by you. The purpose of the conference is to provide an opportunity for an early resolution of the problem with the least amount of difficulty for you. You shall be advised of your rights to have witness present at the conference (authorized agent) to submit any evidence relevant to establishing the facts and circumstances of the dissatisfaction, to offer evidence or testimony, and to cross examine any witnesses, including agency personnel involved in the dispute.

Step 4 If the conference does not lead to informal resolution of your grievance, the EO Officer will take action to file a request for appeal to the appropriate state and/or federal agencies as may be required by funding agency's regulations.

I certify that I have received a copy of the grievance procedures and aware of my rights and responsibilities as a client.

By proceeding with this application I acknowledge that I have been made aware of and understand the grievance procedure for participants of SMILE CAA.

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

Email

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

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 Past Due Rent Document