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City of Spencer

treardon@spenceriowacity.com

418 2nd Ave W, Spencer, IA 51301

(712) 580-7200

SPENCER CARES APPLICATION

This application form must be filled out correctly, and all relevant questions must be answered.  All information on this application will be kept in strict confidence. 

QUALIFICATION GUIDELINES

1) Families must be within 150% of poverty level income.

2017 150% Annual Poverty Level Income

1 2 3 4 5 6 7 8
$18,090 $24,360 $30,630 $36,900 $43,170 $49,440 $55,710 $61,980

For families/households with more than 8 persons, add $4,180 for each additional person.

2)  Number of allowable vehicles (value shall not excees $18,000 per vehicle

Family Size Number of Allowed Vehicles
1 members No more than 1 vehicle
2 members No more than 2 vehicles
3 members No more than 2 vehicles, unless 3 members working
4-7 members No more than 2 vehicles, unless 3 members working

 

3) Maximum Allowed in Checking/Savings/Investment Accounts:

1 2 3 4 5 6 7
$5,000 $5,500 $6,000 $6,500 $7,000 $7,500 $8,000

 

4) Maximum amount of funding per request is $750.

APPLICANT INFORMATION

Please list below your approximate net out of pocket expenses for the year. This will be the cost you paid after Insurance, Title XIX, or any other supplement has paid. 

I certify that the information provided on this applicatin is true and compelte to the best of my knowledge and I authorize the SPENCER CARES COMMITTEE to check for verification of this information as needed. 

Draw Type
I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.