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232-HELP/211 Application
 
 
 
 
  
 

   Preliminary Application
 

If you wish to apply for assistance through one of our programs, please print and return the completed preliminary application to 232-HELP/211,  P.O. Box 52763, Lafayette, LA 70505.

Remember to check the programs you are applying for. This is a preliminary application for screening purposes.  After we have received the application it might be necessary to conduct a phone interview or mail a more detailed program application. 

Please note that submitting a preliminary application does not guarantee assistance.