Project Deserve Application PDF Details

Deserving a project is an important aspect of getting it funded and completed. The Project Deserve Application Form helps project managers and those submitting proposals to provide all the necessary details for their project. This ensures that those reviewing and approving projects have all the information they need to make an informed decision about whether a particular project deserves funding. Project Deserve is an online application form that provides a simple, intuitive platform for creating, submitting, and tracking proposals. This allows individuals or groups to communicate their proposal idea with others in order to build consensus and gather required approvals before submission. It also makes it easy for reviewers to access all proposal materials in one place, removing the hassle of having to track down messy email attachments or misplaced document files.

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QuestionAnswer
Form NameProject Deserve Application
Form Length4 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min
Other namesproject deserve ks, center of hope project deserve application, center of hope, project derserve

Form Preview Example

For office use only:

Project DESERVE Application PM ____/____/200__

This program provides assistance to current Westar Energy customers. Applications may ONLY be submitted by mail through the United States Postal Service. They must be postmarked between the 1st and 7th of the month. Any application with a postmark before the 1st or after the 7th will not be considered. Please see page 3 for other important information and requirements. Assistance is determined on a first-come first-served basis, based on the availability of funds, to those who demonstrate a financial need.

To be eligible for this program, a member of your household must meet one of the following categories:

60 years or older OR Receives permanent disability income

from SSI or SSD

If approved you will be assisted with the amount due on your account at the time of the review, up to $300.

HOUSEHOLD INFORMATION

List all members of your household. Your Westar or Atmos bill must be in the name of an adult living in the household. Begin on line 1 with the person whose name the account is in. Please print legibly.

Name (last, first, MI)

Social Sec #

Sex

Date of

M or F

Birth

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

Meets the income guidelines below

If approved you will be assisted with the amount due on your bill at time of review, up to $100.

Household

Gross Income

 

 

 

Size

Annual

Month

 

 

 

1

$12,287

$1,024

 

 

 

2

$16,643

$1,387

 

 

 

3

$20,999

$1,750

 

 

 

4

$25,355

$2,113

 

 

 

5

$29,711

$2,476

 

 

 

6

$34,067

$2,838

 

 

 

7

$38,423

$3,202

 

 

 

8

$42,779

$3,565

 

 

 

Each add’l

$ 4,356

$ 363

person

 

 

 

 

 

Your address:

Street Address

City

State

Zip

County

Please indicate with a check () below why you need assistance with your bill:

Not Enough Income Monthly Loss of income Unusually High Utility Bill Unusually High Medical Bill

Other (please

explain)_____________________________________________________________________________

Please list the following information from your Westar bill:

Account number ____________________________ Total Bill Amount ____________

Page 1 of 3

Budget Information

 

 

Income Information

 

 

 

 

 

 

 

 

MONTHLY EXPENDITURES

Amount

 

Regular

 

Name of person

Source

Amount

paid this

 

monthly

 

 

month

 

expenses

 

 

 

 

Food

 

 

 

 

 

 

$

 

 

 

 

 

 

 

Household supplies (cleaning,

 

 

 

 

 

 

 

soap bleach, etc.)

 

 

 

 

 

 

$

Shelter (rent, mortgage, paid off)

 

 

 

 

 

 

$

 

 

 

 

 

 

 

Electricity

 

 

 

 

 

 

$

 

 

 

 

 

 

 

Gas/Heating (fuel, oil, wood)

 

 

 

 

 

 

$

 

 

 

 

 

 

 

Water/Sewer

 

 

 

 

 

 

$

 

 

 

 

 

 

 

Trash

 

 

 

 

 

 

$

 

 

 

 

 

 

 

Telephone

 

 

 

 

Monthly Income total

 

$

 

 

 

 

 

 

Clothing

 

 

 

 

Monthly Expenditures

 

$

 

 

 

 

 

 

Transportation (fares, gas, oil)

 

 

 

 

 

 

 

 

 

 

 

 

IMPORTANT!

Property Insurance

 

 

 

 

 

 

 

 

 

Auto Insurance

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Medical Insurance

 

 

 

 

Please include ALL household income

Life/Burial Insurance

 

 

 

 

sources.

 

 

 

 

 

 

 

Source examples include:

 

Taxes (personal property, real

 

 

 

 

 

estate)

 

 

 

 

Employment, SSD, SSI, SS, TAF,

 

 

 

 

 

Medical/Dental/Drug expenses

 

 

 

 

Food Stamps, Unemployment,

 

 

 

 

 

Worker Compensation, Child Support,

Personal needs (haircuts, laundry,

 

 

 

 

diapers, etc.)

 

 

 

 

Alimony, General Assistance (GA),

 

 

 

 

 

School costs (tuition, books)

 

 

 

 

 

 

 

 

etc.

 

 

Recreation (cable, movies, trips,

 

 

 

 

 

 

 

cigarettes, lottery, gifts, etc.)

 

 

 

 

Each source requires official written

 

 

 

 

 

Other (child care, charity, alimony,

 

 

 

 

 

 

 

 

verification.

 

 

church, etc.)

 

 

 

 

 

 

 

 

 

 

 

Examples of verification include:

 

 

 

 

 

 

 

 

 

 

paycheck stubs for last 30 days, letter

Credit Buying - car payments

 

 

 

 

from Social Security office (for current

or other loans, medical bills,

 

 

 

 

 

 

 

 

year), printout from SRS, printout from

charge cards, appliances,

 

 

 

 

furniture, etc.

 

 

 

 

unemployment office, etc.

 

 

 

 

 

 

DO NOT SEND ORIGINAL DOCUMENTS.

 

 

 

 

 

SEND COPIES. ALL DOCUMENTS WILL

 

 

 

 

 

TOTALS

 

 

 

 

BE DESTROYED AFTER REVIEW.

Please read the next page (p. 3) very carefully.

Page 2 of 3

Required Verification

To have your application for assistance considered, written verification of your situation is required. Along with this signed application, you must provide COPIES of the following:

Copies of current verification for each source of income in your household for the last 30 days

Copy of your current Westar Energy bill

Copy of photo ID for every adult in your household

DO NOT include originals as they will not be returned to you. All documents will be destroyed after review.

Notification Information

You will be notified, in writing, of our decision. Please allow up to 4 weeks to receive notification by mail. For those who are approved, payments will show as a credit on your Westar bill.

Please return completed application and verifications to:

American Red Cross

 

Midway-Kansas Chapter

 

Project DESERVE

 

P.O. Box 3726

 

Wichita, KS 67201

Please list the name of any helping agency or organization that helped you complete this application:

READ THE FOLLOWING CAREFULLY BEFORE SIGNING

My signature below means that I understand and agree to all of the following:

I understand it is my responsibility to provide current proof of all household income, a current copy of my bill and photo ID’s of all the adults in my household to determine my eligibility.

I understand I need to continue making regular payments to my energy provider and that any Project Deserve benefits which may be received do not take the place of my responsibility to pay the vendor.

I understand my eligibility will be determined under the Project Deserve guidelines.

I understand this assistance is available one time per year on a first-come, first-served basis to those who demonstrate a financial need.

I authorize my utility provider to release my payment history and other information to the American Red Cross. I also authorize the American Red Cross to release application information to my energy vendor.

I understand applications with incomplete information or verification will not be processed and will be destroyed.

I understand applications may ONLY be submitted by mail through the United States Postal Service and must be postmarked between the 1st and 7th of the month.

I certify that all information I have provided is complete and accurate.

( )

Signature of Adult Household Member

Date

Daytime phone number

Page 3 of 3

Application Process

Applications may ONLY be submitted by mail through the United States Postal Service and must be postmarked between the 1st and 7th of the month. Any application with a postmark before the 1st or after the 7th will not be considered.

If your application is denied you are eligible to reapply. You are eligible for payments from this program only one time per year.

Midway-Kansas Chapter

P.O. Box 3726

Wichita, KS 67201

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