Hotel Voucher Form

Full Name*

E-mail*

Phone Number*

House Hold Size*

Brief Description Of Your Current Situation*

Emergency Hotel Assistance Checklist - Please review the checklist below before submitting your application

Reqired Information - Check each box to Aknowledge that all information sumbited will be vaild documentations

Complete Application
Valid Government Issued Photo ID (Driver License, State Id, Passport)
Emergency Verification ( Eviction Notice, Utility Shut-Off Notice, Referral Letter, Fire Report, Other Supporting Documents)
Birth Certificates Or other child verification Documents (guardianship Paperwork, Insurance Documents etc.)

Important Reminders Check the box to show that you argee

I understand assistance is based on available funding and hotel availability.
I understand I must follow all hotel rules and policies.
I understand I must follow all hotel rules and policies.
I understand damages or additional hotel charges are my responsibility
I have signed the client Agreement section

Today's Date*

Today's Date

By checking the boxes above and moving on to the next page and submitting your application this acknowledge that you agree / have signed the agreement section

Policies & Procedures

Program Guidelines & Client Agreement

Please read the following carefully before submitting you application

1. Program Availability

Emergency hotel assistance is based on available funding, hotel availability, and program guidelines. Submission of an application does not guarantee approval.

2. Length of Assistance

Hotel assistance is intended to provide temporary emergency support and may be limited to a specific number of nights determined by Bestowing Upon Ministries.

3. Verification Requirements

Applicants may be asked to provide identification and documents verifying household members, emergency need, or residency.

4. Hotel Conduct

Clients are expected to follow all hotel rules and policies during their stay. Any damages, excessive cleaning fees, smoking fees, unauthorized guests, or violations are the responsibility of the guest.

5. False Information

Providing false or misleading information may result in denial of assistance and/or disqualification from future programs.

6. Safety & Illegal Activity

Illegal activity, violence, drug use, threats, or disruptive behavior will not be tolerated and may result in immediate termination of assistance.

7. Check-In & Check-Out

Clients are responsible for checking into and out of the hotel on time and complying with all hotel procedures.

8. Confidentiality

Information provided will be kept confidential to the extent permitted by law and used only for program-related purposes.

9. Release of Liability

Bestowing Upon Ministries is not responsible for lost, stolen, or damaged personal belongings, injuries, or incidents that occur during the hotel stay.

Emergency Assistance Questions

If Other Explain or N/A*

Previous Assistance

Have you received hotel or emergency housing assistance before?

Yes
No

If Yes Explain or N/A*

Income Information

Is anyone in the household currently employed?

Yes
No

If Yes Monthly household income (estimate): or N/A*

Job Name & Position or N\A*

Household Safety