By submission of this form, I attest that all the information on this form is true and accurate to the best of my knowledge. I understand that any information written or verbal that I offer may be shared with other members of the Vermont Catholic Charities Emergency Aid staff as well as any members of agencies involved. I grant Vermont Catholic Charities and St. John Vianney Parish permission to contact my listed resources/agencies/landlord or utilities to verify need. I understand that I may not be eligible for assistance if I have received it recently from Vermont Catholic Charities, or previously multiple times.