Jefferson County Community Partnership
Thursday, February 23, 2012
Working Together to Create a Better Future

Don't miss out on a night of
food, fun, and fundraising!
Join us at JCCP's
"A Night of Comedy"
CLICK HERE to purchase tickets!
 
 
 
Privacy Policy
JCCP will not rent, trade, sell or share any information about its donors.  Donors will be recognized publicly for their contributions only with their permission.
Click here for complete policy.
 
 

Rebuilding Together Application

        


Thanks for your interest in Rebuilding Together.

Please complete the following forms and someone will be in contact with you shortly.
 
 
                           



 

  Date of Birth:    

 

                   Estimated Monthly Household Income:

                   Household Disabilities:

                   Home Type:
  Ownership Status:

                  Primary Need:
  (Hold Conrol Key down to select more than one)


                  Priority 1:

                  Priority 2:

                  Priority 3:

                 

Sign up for our Email Newsletter icon, E-mail Newsletter icon, Email List icon, E-mail List iconEmail Newsletter   
For Email Marketing you can trust