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  2. TAX STATUS (check one):
  3. Previous Emergency Fund Recipient?
  4. NOTE:
    The Emergency Fund is intended to assist agencies with a short-term urgent funding need that has or will significantly interrupt essential services or impact the health and safety of the homeless population.
  5. Examples Include:
    - Natural disasters (e.g. fire, flood, tornado, storm damage, loss of utilities)
  6. - Emergency needs (e.g. phase-out costs associated with closing a program due to a sudden loss of funding, equipment failure, civil disturbance, severe weather events, or other conditions determined by the Cowlitz county Health Officer to be an emergent threat to public health and safety.)
  7. * All projects must be eligible activities as specified by the State of Washington for the use of Homeless Housing Document Recording Fees.
  8. * Applicants should be aware that this is a short-term funding opportunity, and that each application is considered on its merits within established eligibility criteria. The filing of an application is not, nor should be perceived as a guarantee of funding.
  9. Emergency Fund Requests will not be considered for the following purposes:
    - To “bail out” agencies due to mismanagement or budget shortfalls - To assist individual applicants - To provide services outside of Cowlitz County - For sectarian or religious purposes - For political purposes - To support ongoing program work
  10. Please attach a budget that provides an overview of the total cost of the project and that details the costs being requested for reimbursement through this fund. Please also include any requests made through other fund sources that have been committed, pending, or declined. The budget should include a breakdown of what the funds would go towards (personnel, supplies, equipment, etc).
  11. Leave This Blank:

  12. This field is not part of the form submission.