received (via mail or online) by June 4, 2021 will receive priority. If funding
is still available after this date, additional eligible applicants will receive
vouchers on a first come first serve basis.
Homage Services (425) 513-1900 or Snohomish County (425) 388-7393
Please type in your name
Physical location of where you are when submitting this form.
This institution is prohibited from discriminating on the basis of sex, race, creed, religion, color, national origin, age, veteran or military status, sexual orientation, disability or the use of a dog guide or trained service animal (a service animal is an animal that is individually trained to do work or perform tasks for the benefit of an individual with a disability). (RCW 49.60.030)
USDA Nondiscrimination Statement
In accordance with the Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations anf policies, the USDA, its Agencies, offices and employees and institutions participating in or administrating USDA programs are also prohibited from discriminating based on race, color, national origin, sex, disability, age or reprisal or retaliation for prior civil rights activity conducted or funded by USDA.
Persons with disabilities who require alternative means of communication for program information (e.g. Braille, large print, audiotape, American Sign Language, etc.), should contact the Agency (State or local) where they applied for benefits. Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program information may be made available in languages other than English.
To file a program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, (AD-3027) found online at:
http://www.ascr.usda.gov/complaint_filing_cust.html, and at any USDA office, or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by:
(1) Mail complaint of discrimination to:
U.S. Department of Agriculture
Office of the Assistant Secretary for Civil Rights
1400 Independence Avenue , SW
Washington, D.C. 20250-9410; NOTE: DO NOT MAIL SFMNP Application to this address
(2) Fax complaint of discrimination to: (202) 690-7442; or
(3) Email complaint of discrimination to: email@example.com.
This institution is an equal opportunity provider
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