Form Center

2. For more information, contact Chasta White in the Department of Community Development at 799-5260, ext. 2506
   This program will help distribute air purifiers to low income families who have had a positive COVID-19 test in the last 30 days and who are or may have high risk family members in the household.
4. Contact Information
6. Name*
8. Current Address*
10. City*
11. State*
12. Zip*
14. Phone Number*
15. Alternate Phone Number
17. Email
19. Required Documentation
    Please complete and upload all required documentation . Incomplete application(s) or any missing documentation may delay processing your request.
21. Air Purification Program
    This requires 6 total files to be uploaded.
23. PDF Application
    Air Purification Program Application (PDF)

    Please download this application, fill out, and save.
24. Application
    Upload completed Application
26. Please upload your last three (3) paystubs and one (1) prior to March 25, 2020
28. Paystub 1
29. Paystub 2
30. Paystub 3
32. Please fill out your email below to receive a copy of your submission.
Leave This Blank:


34. 1. Receive an email copy of this form.
35. Email address

    This field is not part of the form submission.

36. Submit

* indicates a required field