I hereby request and will accept assistance from the Alliance for Interfaith Ministries (AIM) and agree to abide by its outlined procedures. I understand that I will receive no money directly even if my application is approved. I authorize AIM to take the above information and not to hold them liable for any inadvertent disclosures. I further agree not to hold AIM liable for any services or lack of receipt of services by a volunteer or AIM staff or one of the providers or other agencies with whom it cooperates.

I also hereby give AIM the permission to verify all information that I have provided by communicating with any service providers, employers, landlords, and others needed to verify the information I provide and to share any information needed to secure assistance. I also give AIM permission to share information about AIM assistance I have received or will receive with AIM member congregations and other agencies as necessary to either verify need for additional assistance from a member congregation or other agency or to prevent duplication of assistance. Unless otherwise stated to AIM, I have not and will not apply for assistance with this same need at any other agency.

I hereby attest that all information provided herein is accurate and complete and understand that providing AIM representatives with inaccurate or incomplete information may constitute fraudulent activity, which will be reported to law enforcement.