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2. 
4. Temporary Assistance Fund (TAF) Application
   To apply for a Temporary Assistance Fund Grant, complete the application below. For information on the policies and criteria for a TAF, visit www.helpinghandsup.org/resources. If you have any questions, email HHUniversityPark@gmail.com or call (301) 892-6636 for assistance.
6. Name of Applicant:*
7. Birth Year*
9. Applicant Street Address:*
10. University Park, MD 20782
12. Applicant Email:
13. Applicant Phone Number:*
15. Name of Individual Providing Information (if not Applicant) and Provide Contact Information:
    Include relationship to Applicant and provide an email address and/or phone number.
19. Nature of the TAF Request (Describe need and amount of money requested):*
21. Others in Applicant's Household:
23. Name:
24. Relationship:
26. Name:
27. Relationship:
29. List Additional Household Members (if applicable):
31. Total Household Monthly Income:*
33. Income Source(s):*
35. Total Household Monthly Expenses:*
37. The Undersigned hereby certify that, as the date hereof, the above information is true and correct to the best of the Undersigned's knowledge, information and belief.
39. By typing your name, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature.
41. TAF Applicant Signature:*
42. Date:*
    Date:
44. Individual Providing Information Signature (if applicable):
45. Date:
    Date:
47. Witness:
48. Date:
    Date:
Leave This Blank:


50. 1. Receive an email copy of this form.
51. Email address

    This field is not part of the form submission.

52. Submit Submit and Print

* indicates a required field