Move-In Flex Fund Application

Date of Flex Fund Application

mm/dd/yyyy

By checking this box, I acknowledge that Flex Fund claims may only be submitted for costs that are not covered by the household's supporting agency or housing program.

Vendor Name

What is the legal name of the entity who is in need of payment?

Vendor Mailing Address

Client Name

First & Last Name

Description of Expense

Expense Category

Amount

Name of Case Manager Completing Form

Email of Case Manager/Agency

Attach Relevant Documents

Upload conditional approval letters, invoices or receipts, etc.

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