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 APPLICATION FOR SERVICES
General Information







Thank you for filling out a Metrocrest Services Application. We have determined you are ineligible for services at this time, for the following reason: 

Currently living outside of the service area.
 
We understand the urgency of your situation, especially during these challenging times. A complete list of additional helpful resources can be found online at www.findhelp.org 





Contact Information





















Household Members


















Household Members
Please provide the names, birthdate and gender of all household members. Click on "Add another household member" to add more members.











$





Physical and Mental Health
If you've answered yes to this question, please do not continue with this application and call 911 for immediate assistance.
If you answered no to this question and are unable to come and go as you please, please dial 911 for help or call the National Trafficking Hotline at 1-888-373-7888
Information collected below will be used to determine additional services you may be eligible for.  
Yes No Unknown
If you checked yes and are fleeing domestic violence, please do not continue with this application and call 911 for immediate assistance. Help can also be reached by calling a domestic violence hotline.

In Denton County call: Friends of The Family 940-382-7273

In Dallas County call or text: Genesis Women's Shelter 214-946-4357
The Family Place 214-941-1991
Brighter Tomorrow 972-262-8383

In Collin County call: Hope's Door New Beginnings Center 972-276-0057




Assistance



Senior Services


Utilities



Housing
We are only able to provide current and future months of assistance.




Once you have received a writ of possession, Metrocrest Services is no longer able to assist you with your housing efforts. We may be able to provide other services to you in our Workforce, Financial Empowerment or Pantry services upon your request.






Yes No Unknown






Employment Information






Yes No




Employment Details








Please make edits if any of the below questions have changed.
Financial Capability
No Yes
Not at all Somewhat Very
Household Financials


Household Income

Please list the amount your household receives each month for the following:
Please enter numbers only below
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Total based on amounts input above
Household Expenses
Please list the amount your household spends each month on the following:
Please enter numbers only below

$

$

$

$

$

$

$

$

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File Uploads

Certifications



Metrocrest Services operates in accordance with the US Department of Agriculture and Texas Health and Human Services Commission policy, which prohibits discrimination on the basis of race, color, sex, age, disability, religion, political belief, or national origin. Social Security numbers are not required in order to receive food, rental, and utilities assistance. Metrocrest Services has my permission to exchange information regarding my circumstances with other Human Service Agencies. I understand that information on this form may be verified. I understand that inappropriate behavior may result in loss of services.

1. I am a member of the household living at the address provided and, on behalf of the household, I apply for USDA Foods that are distributed through The Emergency Food Assistance Program.

2. All information provided to the agency determining my household’s eligibility is, to the best of my knowledge and belief, true and correct, and

3. If applicable, the information provided by the household’s Authorized Representative is also, to the best of my knowledge and belief, true and correct.

In accordance with federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, this institution is prohibited from discriminating on the basis of race, color, national origin, sex (including gender identity and sexual orientation), disability, age, or reprisal or retaliation for prior civil rights activity.

 

 Program information may be made available in languages other than English. Persons with disabilities who require alternative means of communication to obtain program information (e.g. Braille, large print, audiotape, American Sign Language), should contact the responsible state or local agency that administers the program or USDA’s TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA through the Federal Relay Service at (800) 877-8339.

 

 To file a program discrimination complaint, a Complainant should complete a Form AD-3027, USDA Program Discrimination Complaint Form which can be obtained online at: https://www.usda.gov/sites/default/files/documents/USDA-OASCR%20P-Complaint-Form-0508-0002-508-11-28-17Fax2Mail.pdf, from any USDA office, by calling, (866) 632-9992, or by writing a letter addressed to USDA. The letter must contain the complainant’s name, address, telephone number, and a written description of the alleged discriminatory action in sufficient detail to inform the Assistant Secretary for Civil Rights (ASCR) about the nature and date of an alleged civil rights violation. The completed AD-3027 form or letter must be submitted to USDA by: (1) mail: U.S. Department of Agriculture, Office of the Assistant Secretary for Civil Rights, 1400 Independence Avenue, SW

Washington, D.C. 20250-9410; or (2) fax: (833) 256-1665 or (202) 690-7442; or (3) email: program.intake@usda.gov.

 

This institution is an equal opportunity provider.


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