The AT HOME Group!" Assistance Application

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The AT HOME Group!" Assistance Application

Submit completed application to: Stephanie Silvers, AT HOME GROUP
P.O. Box 50277, Minneapolis, MN 55405
Phone: 612.277.0216 - Fax: 612.767.3959

Applicant Name:	Application Date:
Applicant Phone Number:
Applicant Mailing Address:
Applicants City:
Applicants State:	For Minnesota Residents Only
Applicants ZipCode:
Alternative Contact Name: (Someone who will know how to contact you)
Alternative Contact Phone Number: (Someone who will know how to contact you)
E-mail Address:
*Name of Residence:* (if applicable)

If you have submitted an application and have not heard back from anyone within a week please call the office number listed above.

Please describe your living situation:

What program are you applying to (you can only choose one):
Tools for the Job - looking for tools, uniform, or an item necessary for your job. Please bring a list of items needed and costs. (up to $500)

Education - looking to receive training for a trade or to receive a license. Please provide the name and information on your program. (covers up to $1,200)

Your Own Business-Start up expenses to help start a small business. A business plan and business budget need to be submitted with this application.
($2,000 limit)

Please explain what item or service you need and how it will help you secure and/or maintain work:

How did you hear about us?

Required:
Please list other ways or places you have tried to get help for the above request: