The Dubbers Care Foundation grants financial support to families in Western Montana to support their housing needs during an emergency or financial crisis.

Grants are awarded on a case-by-case basis after verification of the applicants need and availability of grant funds. All Grants are awarded by the Board of Directors for Dubbers Cares.

All funds are disbursed directly to the housing entity (Landlord, hotel, utility company, etc.).

Please answer the following questions to the best of your ability
with as much detail as possible.

An incomplete application or not providing adequate details
could result in an automatic denial.

Name

First Name

Last Name

Phone

(###)

###

####

List all who reside in home & will benefit from assistance

How much is your monthly rent?

How much do you currently owe?

The dollar amount you are requesting ($1,500 is our max per applicant)

If you owe more than our max allowed $1,500, please explain how our funds will impact the situation in a significant way

For what purpose (ex: Hotel Stay, Mortgage, Rent, Security Deposit, etc)

Are you currently behind on rent? If so, how many months? (if applicable)

Are you currently employed? If so, where?

How did you hear about our organization?

Are you currently working with a Case Worker for any other financial assistance (YWCA, 549-Hope, Western MT Mental Health Clinic, etc)? Do we have permission to contact them?

Case Worker's Name, Email and Phone Number

Have you applied for assistance elsewhere? Where and what was the outcome?

If you currently have a landlord, please fill out our Release Form at the bottom of this page, giving us permission to talk to them directly. **Do you give us permission to talk to them directly?**

Please provide a DETAILED description of the situation.

Please provide a DETAILED description of the events that lead to the financial hardship.

What are your Future plans of Navigating the financial situation?

Date

YYYY

The Dubbers Care Foundation grants financial support to families in Western Montana to support their housing needs during an emergency or financial crisis. I hereby authorize the release of information concerning my stay at the following property:

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Applicant/Tenant Name

First Name

Last Name

Applicant/Tenant Name

First Name

Last Name

Date

YYYY

Landlord/Property Management Contact Information:

Phone

(###)

###

####

By submitting this form, you give The Dubbers Care Foundation authorization to request information which can include but is not limited to duration of stay, rent amounts, payment history, outstanding balances, and issues concerning compliance with or infringement on the policies and provisions in the Housing Agreement.