ST: JOHN PAUL II SYRO MALABAR CATHOLIC CHURCH
COVID19 RELIEF PROGRAM APPLICATION
Name
First Name Last Name
E-mail
Phone Number
Area Code Phone Number
Address
Street Address
Street Address Line 2
City State / Province
Postal / Zip Code Country
Are you an International Student, temporary Foreign Worker, Permanent Resident or Citizen:
Please describe your recent change of income:
Are you currently receiving any income or government assistance?: *
Do you need emergency assistance to meet living expenses from church due to reduced income *

ST: JOHN PAUL II SYRO MALABAR CATHOLIC CHURCH