Hope Application

Qualifications for HOPE of the Grand Valley

Children under the age of 14 in your home full time or joint custody

At least one working adult in your family (most recent pay-stub required with application)

I do not receive SNAP, TANF or housing assistance because you make a little too much income.

Provide SS Card or Birth Certificate for each child in home full time.

Provide ID with Colorado Residency

Full Name
*
Email Address
*
Phone Number
*
Date
*
Address
*
- Street Address
- Address Line 2
- City
- State / Province / Region
- Postal / Zip Code
- Country
Please check all that apply
*

I am working full time
I have childen under the age of 14 in my home.
I am a Mesa County Colorado resident
I do not receive government assistance because I make a little too much at my job.
I do receive some assistance
If you checked I do receive some assistance please explain. We do accept; LEAP, CCAP, Medicaid, CHP and CHP +
What type of assistance are you needing?
*
Please tell us about you and your family situation
*
Please click on the checkbox to continue
*