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Is this address a shelter?
Names and ages of your children under 18 living with you:
List your valid MINNESOTA DRIVER’S LICENSE number:
Name and address of current employer:
Are you currently receiving government assistance or subsidies:
List the names of subsidies and amounts of each:
Date you started working with this employer:
Average number of hours worked per week:
Monthly or Biweekly net (take-home) income (monthly or biweekly):
Monthly net amount:
Biweekly Net Amount
Employer or Supervisor contact:
Are you currently enrolled in school working towards a degree or certificate:
Name and Address of School:
Degree or program you are working on:
Please give a brief explanation of your current situation and why you are in need of a vehicle:
Please list a professional referral that we can call to verify some or all of the above information. We ask that you do not list a relative.
Examples: Teacher, Church Leader, Case Worker, Medical Counselor, Business Leader, Social Worker.
Would you be open to a short interview and a photograph for our website?