COVID-19 Application

Status message

ELIGIBILITY CRITERIA:

  • Must be 18 years of age or older
  • Indiana County Resident
  • Unemployed/loss of income due to COVID-19

Household Information
Please list the Name(s) of all other adults living in your Household (18 and older)
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Mailing Address
Please indicate the number of individuals in your household in each age category below (enter a 0 if there are none in that age group):
I Need Assistance With
Note: These funds are NOT to be used to purchase alcohol, nicotine, or any illegal substances.
Prior to receiving assistance, you must first submit a copy of your valid driver’s license, or ID, as well as either proof of application/determination letter for unemployment compensation or letter from employer.
Upload requirements
Upload requirements
I understand that this information is utilized to determine eligibility for the COVID-19 Disaster Relief Fund for which I am applying. I hereby certify to the best of my knowledge, the information contained herein is true, and correct.  My signature also gives permission for ICCAP to sign the Project Share Release Form on my behalf.  Project Share is an Indiana County database which records assistance provided through this special fund, tracking the monies provided to residents of the county and for the purpose for which they intend to use the monies.  Read the Project Share Release Form here.