Step 1: For a complete set of rules, visit www.crawfordhoying.

com
Step 2: Complete this form. Date of Birth is required.
Step 3: Submit your nomination by: foundation

Stamp
Place

Here
Folding, stamping, and mailing this form
OR emailing responses to:
laura.black@use.salvationarmy.org
OR faxing completed form to: (614) 221-1896

Nominations are due by 5:00pm on Mar. 5, 2014

Winners will be notified by Mar. 26, 2014

Head of Household’s Name:

Date of Birth: M / F:

Family’s Current Address:

attn: Laura Black, The Salvation Army

Nomination Date: Nominate a Family In Need
Please List Other Family Members Who Would Live in the Home:
to Receive an Apartment
Rent-Free for One Year
Name #2 Date of Birth M/F

Columbus, OH 43205
Relationship to Head of Household
Homes of Hope

Name #3 Date of Birth M/F 966 E Main St

Relationship to Head of Household

Name #4 Date of Birth M/F

Relationship to Head of Household

Name #5 Date of Birth M/F For additional details visit our website or give us a call

Relationship to Head of Household

www.crawfordhoying.com
(614) 335-2020
 Is the family having a housing crisis? (homeless, facing eviction,
or living doubled up with family/friends? Y N
Why should this family receive a free apartment home for one year from Crawford Hoying Living?
If yes, please explain:

Has anyone in the family ever been evicted? Y N

If so, who and when?

Does anyone in the family have a police record? Y N

If yes, have any adults had a felony? Y N

If yes, what type of felony?

Does the family have any past-due utility bills? Y N

Amount owed to gas company?

Amount owed to electric company?

What area of town would the family prefer to live?

Is the head of the houehold currently employed? Y N

If no, please explain:

What is the total monthly household income?

Please list each income source separately:

Monthly Amount Income Type Pay Frequency

(e.g. monthly)

Please list other organizations, professionals, or persons that

we may contact in order to verify this family’s situation:

I certify that the above information is true and accurate. I also understand that this is only a nomination and does
not guarantee that this family will receive an apartment home from Crawford Hoying Living. Date:
May we contact you and/or the family if the family is going to be
Your Name: Phone: Address: considered for an apartment home? Y N

Best method of contact: (circle one) Phone Email

Phone number:
Secondary phone number:
Email address:

foundation