Skip to form

City of Inglewood

CDBG@cityofinglewood.org

1 W Manchester Blvd, Inglewood, CA, 90301, US

310-412-5575

image

COVID-19 Debit Card Program Application

Name

Address

Date of Birth

Are you a City of Inglewood Resident?

Do you rent housing in Inglewood?

Please select the zip code you live in:

The City reserves the right to establish priority preferences that do not discriminate on the basis of race, color, religion, sex, national origin, disability, or familial status. The City’s priority preference will be given to the elderly (62 or over), the permanently disabled, Inglewood residents that are unemployed or underemployed due to COVID-19 (those that can prove that they were forced to seek employment paying less than their previous job which was eliminated due to the COVID-19 pandemic) and extremely low-income, very low-income individuals and families meeting the Median Family Income (MFI) Limits listed below. Examples of acceptable priority factors may include: Check box if you meet a priority preference.

Household

Size

Extremely Low

(30%)

Very Low

(50%)

1 Person

$23,700

$39,450

2 Person

$27,050

$45,050

3 Person

$30,450

$50,700

4 Person

$33,800

$56,300

5 Person

$36,550

$60,850

6 Person

$39,250

$65,350

7 Person

$41,950

$68,950

8 Person

$44,650

$74,350