HWAP Referral

Do you live within city limits?

Yes
No

County of Residence

Erie
Huron
Lorain
Ottawa
Sandusky
Seneca
Wood

Have you applied for HWAP before?

Yes
No

Income for all occupants over 18 years old (Select all that apply)

Self-Employed
Employed
Social Security\SSI\SSD
Public Assistance- ADC\TANF
Unemployment
Workers Compensation
Child Support
Pensions
No Income

How did you learn about our program?

Facebook, Instagram or other Social Media
Family or Friends
GLCAP Staff Member
Newspaper
Social Service Agency (Dept. of Job & Family Services, OhioMeansJobs, etc.)
Television or radio
Other

Please choose where we may send an application.

Email
Home Address

I consent to receive text messages from GLCAP

Yes