CSBG Application Form

Despite the presence of COVID-19 here in our community, we are continuing to provide supportive services to our customers. COVID-19 relief services are being offered through the Community Services Block Grant (CSBG). Services Include Rental/Mortgage Assistance, Water Bill Assistance, Food Voucher Assistance, Telephone Bill Assistance, Disinfectant/Cleaning Supplies, and Diaper Voucher Assistance. Vouchers Are Provided To Families Impacted By The COVID Pandemic. To apply for COVID-19 relief services complete online application below and then select and complete the COVID-19 Relief Services documents.

Need Additional Assistance Contact PCCEO At: (309) 671-3900.

APPLICATION INFORMATION:

SSN: (Required)

Date of Birth: (Required)

Phone: (Required)

Email: (Required)

Last Name: (Required)

First Name: (Required)

Street Address: (Required)

City: (Required)

Zip: (Required)

Gender: (Required)

Disabled: (Required)

Food Stamps: (Required)

Health Insurance: (Required)

Veteran: (Required)

Ethnicity: (Required)

Education Level: (Required)

No. of persons in your household including yourself: (Required)

Type of Farmer: (Required)

Family Type: (Required)

Housing Status: (Required)

Head Start/Early Head Start Parent: (Required)

Sources(s) of Household Income: (Required)

SPOUSE AND DEPENDENT INFORMATION: (OPTIONAL)

SSN:

Date of Birth:

Gender:

Last Name:

First Name:

Relationship:

Disabled:

Ethnicity:

Education Level: (Required)

SSN:

Date of Birth:

Gender:

Last Name:

First Name:

Relationship:

Disabled:

Ethnicity:

Education Level:

SSN:

Date of Birth:

Gender:

Last Name:

First Name:

Relationship:

Disabled:

Ethnicity:

Education Level:

SSN:

Date of Birth:

Gender:

Last Name:

First Name:

Relationship:

Disabled:

Ethnicity:

Education Level:

SSN:

Date of Birth:

Gender:

Last Name:

First Name:

Relationship:

Disabled:

Ethnicity:

Education Level:

** After you have completed this portion of the application, you will need to select from the following options the application that best fits your need. These additional forms must be filled out and returned with the other supporting documentation.

Rental/Mortgage Assistance Application
COVID-19 Relief Services Application
Prescription Assistance Application
Food Voucher Assistance Application
Lodging Assistance Application
Expungement Application
Bus Pass Assistance Application

CSBG Application Form

APPLICATION INFORMATION:

SPOUSE AND DEPENDENT INFORMATION: (OPTIONAL)

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