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2. Household Support Grant Application

   The City of Snohomish is offering Household Support Grants to qualifying residents to help meet needs associated with the ongoing effects of the COVID-19 pandemic. Up to $2,500 grants are available to help defray expenses such as rent, childcare, utilities, medical bills, car repair bills, or other household expenses per calendar year.

   The two principal eligibility criteria are:

   1. Must live within the Snohomish city limits (go to the City's property map to see if you are a resident) and
   2. The household must meet at least one of the following criteria:

   A. Earn no more than 60% of the Snohomish median income. The income break-down for household size is as follows:

4. 

6. B. Qualify for assistance under at least one of the listed programs from the US Department of Treasury Final Rule. The programs that pre-qualify a person are: 

   -Children’s Health Insurance Program (CHIP)

   -Childcare Subsidies through the Child Care and Development Fund (CCDF) Program

   -Medicaid

   -National Housing Trust Fund (HTF), for affordable housing programs only

   -Home Investment Partnerships Program (HOME), for affordable housing programs only

   -Temporary Assistance for Needy Families (TANF)

   -Supplemental Nutrition Assistance Program (SNAP)

   -Free and Reduced-Price Lunch (NSLP) and/or School Breakfast (SBP) programs

   -Medicare Part D Low-income Subsidies

   -Supplemental Security Income (SSI)

   -Head Start and/or Early Head Start

   -Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)

   -Section 8 Vouchers

   -Low-Income Home Energy Assistance Program (LIHEAP)

   -Pell Grants

   If you and your household meet these criteria, please fill out the application request below. You will be contacted within approximately 10 business days by an employee with the City of Snohomish.

   City of Snohomish Household Support Grant application requests are processed in the order they are received. All fields are required in order to be considered for application.
8. Please note all information below is required to request an application
10. First Name*
11. Last Name*
13. Resident Address*
14. City*
16. I confirm that my household is located with the City of Snohomish city limits. (Please note Household Grant Support is only for current City of Snohomish Residents). *

    1. Yes
    2. No
18. Phone Number*
19. Email Address:*
20. Are you currently unemployed?*

    1. Yes
    2. No
22. What is the average total of your household’s monthly income, over the last three months? Please include earned income, government benefits, and any other sources of income. (If there has been a change since last month, estimate this month’s total household income):*
23. What types of bills would you like any grant monies to pay for?*

    If you are eligible, we may be able to provide up to $2,500 in grant money. What types of bills would you like any grant monies to pay for? Check all that apply.

    1. Rent
    2. Mortgage
    3. Water utility bill
    4. Medical bills
    5. Groceries

    1. Gas
    2. Child care expenses
    3. Internet access
    4. Other (please specify below)
25. How many persons live in your household?*
    -- Select One --12345678
26. Other household expenses
28. I hereby certify under the penalty of perjury of the Laws of the State of Washington that the information on this application is true and correct to the best of my knowledge and belief.*
29. Date
    Date
31. “This project was supported by a grant awarded by US Department of the Treasury. Points of view in this document are those of the author and do not necessarily represent the official position or policies of the US Department of the Treasury. Grant funds are administered by the Local Government Coronavirus Relief Fund thru the Washington State Department of Commerce.”
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35. 1. Receive an email copy of this form.
36. Email address

    This field is not part of the form submission.

37. Submit

* indicates a required field