| User Role | staff | subscriber |
|---|
| Previous Status | 04 Incomplete Application | N |
|---|
| First | Pedro | Inez |
|---|
| Last | Green | Walker |
|---|
| Phone (Main) | (254) 206-5729
| (254) 550-0860
|
|---|
| Phone (Second) | (254) 652-6987 | No Value |
|---|
| Email Address | jclark@missionwaco.org | 64inezwalker@gmail.com |
|---|
| First Name | Pedro | Inez |
|---|
| Last Name | Green | Walker |
|---|
| Are there adults in the household over age 62? | Yes | No |
|---|
| Gender of applicant? | Male | Female |
|---|
| Self-identified race of household? | Multi-Racial/Other | Black or African American |
|---|
| Self-identified ethnicity of household? | Hispanic or Latino
| Not Hispanic or Latino
|
|---|
| First Name | Pedro | Inez |
|---|
| Last Name | Green | Walker |
|---|
| Birthdate | 1960-04-25
| 1960-05-30
|
|---|
| Are you able to provide the required income documentation? | No | Yes |
|---|
| I certify that the income provided is accurate. (Initials) | https://wha-hss.wpmgjobs.com/index.php?gf-signature=62d0eaa6058e85.38551479&form-id=5&field-id=325&hash=5e6e28644c245116e8b82cad3d3b458bfd307d219fca561490a9768e1d8d4c16
| https://wha-hss.wpmgjobs.com/index.php?gf-signature=640ba3f09c2871.64676156&form-id=5&field-id=325&hash=814d38f76f408652377d2fc664975c0bcc17c16e56d0b76643bf77fcc53d6b35
|
|---|
| Please briefly explain why you are unable to provide the required documentation. | Client is disabled and pending disability claim. | No Value |
|---|
| Applicant Signature | https://wha-hss.wpmgjobs.com/index.php?gf-signature=62d0eaa6115941.38448222&form-id=5&field-id=238&hash=4c0a1d43ee1f14e3b37ebb8305890d5b2b73f1972c80fc6e80f19c27f2c37632 | No Value |
|---|
| Date | 2022-07-14 | No Value |
|---|
| Employment Assistance | Employment Assistance | No Value |
|---|
| Applicant Signature | https://wha-hss.wpmgjobs.com/index.php?gf-signature=62d0eaa6169e05.77944815&form-id=5&field-id=265&hash=65b0ea7a7ddd45d7130f7eb107107b5ba425c3d3036a8af83e70d9a66b83fe59
| https://wha-hss.wpmgjobs.com/index.php?gf-signature=640ba3f0aca452.33972234&form-id=5&field-id=265&hash=fe99e37f05c39379f0d1f2db334b4015732f1f66d069c00bf44ee75118f3f589
|
|---|
| Date | 2022-07-14 | 2023-03-10 |
|---|
| Applicant Signature | https://wha-hss.wpmgjobs.com/index.php?gf-signature=62d0eaa61b9891.81121346&form-id=5&field-id=272&hash=b1d4c6ff3616d5d981bc484e4aa4dca11810b43fb107342525b7063a05bd9dab
| https://wha-hss.wpmgjobs.com/index.php?gf-signature=640ba3f0c5eee0.70080242&form-id=5&field-id=272&hash=383b3831c5e2e132738bf382ebda8a9dcc9d8f285a745abad4044e6bb44515c4
|
|---|
| Date | 2022-07-14 | 2023-03-10 |
|---|
| Initials | https://wha-hss.wpmgjobs.com/index.php?gf-signature=62d0eaa6206b73.24395325&form-id=5&field-id=328&hash=03a7e0c4837cb75fe1ed2646294248718413b47c1d85f4d1af32d99460ae6353
| https://wha-hss.wpmgjobs.com/index.php?gf-signature=640ba3f0df6a56.83191386&form-id=5&field-id=328&hash=18cd21cc1a21d78302cf6e793d0cffc701052a0221506426da878f716424e5ef
|
|---|
| First | Pedro | Inez |
|---|
| Last | Green | Walker |
|---|
| Applicant Signature | https://wha-hss.wpmgjobs.com/index.php?gf-signature=62d0eaa6251bc3.40706754&form-id=5&field-id=206&hash=759d59f180e02d47674d2e0d09cf08db23572ad0bbe419dfd864cc56417ca649
| https://wha-hss.wpmgjobs.com/index.php?gf-signature=640ba3f1029528.44493091&form-id=5&field-id=206&hash=a3a03146dd5a6a0d63c9dcc3d41e11e2cdfc146a3ac1e3a39a56c2515b2fbba2
|
|---|
| Date | 2022-07-14 | 2023-03-10 |
|---|
| Legacy Uploads | No Value | https://wha-hss.wpmgjobs.com/wp-content/uploads/gravity_forms/5-9d5610a5e7b64c278cbfb60f5978e15b/2023/03/CamScanner-03-10-2023-15.14.pdf , https://wha-hss.wpmgjobs.com/wp-content/uploads/gravity_forms/5-9d5610a5e7b64c278cbfb60f5978e15b/2023/03/CamScanner-03-10-2023-14.51.pdf , https://wha-hss.wpmgjobs.com/wp-content/uploads/gravity_forms/5-9d5610a5e7b64c278cbfb60f5978e15b/2023/03/CamScanner-03-10-2023-15.16.pdf |
|---|
| Applicant Signature | https://wha-hss.wpmgjobs.com/index.php?gf-signature=62d0eaa62a3039.78441427&form-id=5&field-id=28&hash=4e4e2bcdee3f48a04a5f935c0f5e320d5bb80375a5a6c75b9ae4babf6ece8c88
| https://wha-hss.wpmgjobs.com/index.php?gf-signature=640ba3f117c3c5.63731053&form-id=5&field-id=28&hash=c80f8e24bc32426a4ed92d29c69d99383eef9c763494c260e498cb5864a2bab2
|
|---|
| Mail Batch | No Value | 1 |
|---|
Eviction Prevention (Appeals Bond) EVICTION DIVERSION SERVICES Field ID: 22.1 | No Value | Eviction Prevention (Appeals Bond) |
|---|
Legal Fees EVICTION DIVERSION SERVICES Field ID: 22.2 | No Value | Legal Fees |
|---|
Dispute Resolution EVICTION DIVERSION SERVICES Field ID: 22.3 | No Value | Dispute Resolution |
|---|
| Moving Fees | No Value | Moving Fees |
|---|
| Briefly explain how Covid-19 has impacted your ability to make rent and/or utility payments. | No Value | I am unable to work due to disability, and the cost of living and inflation has gone up since COVID. Before I could make it work with my SSI but now the rent, and the bills are too much to afford with my SSI check. |
|---|
| Picture ID (required) | No Value | Picture ID (required) |
|---|
| Income | No Value | Food Stamps |
|---|
| App Fee | No Value | ID (required) |
|---|
