P2G Assistance Application Form
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Language: EnglishEspañol
I Need Assistance With: ElectricityGasWaterRentOther
Amount:
I certify that I will not withhold any information that would unfavorably affect my application to receive assistance from Passion2Give. I understand that information contained on my application will be verified by Passion2Give, and any misrepresentation(s) may be cause for my immediate rejection to receive assistance from Passion2Give.
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Rights and Waiver
I hereby authorize Passion2Give to photograph, take videos, and/or interview me if necessary.
Electronic Signature: (Please type full name) Date:
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