Cutting Costs Program Application

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Street Address

Apartment

City

State

Zip

The total number of individuals in household:

The total number of people in the household who need to follow a gluten-free diet?

Total Household Gross Income. GIG Cares may request verification of income prior to awarding assistance.

$58,662 or greater

$43, 997 to $58,661

$29,332 to $43,996

$14,666 to $29,331

$14,665 or less

Do you receive any other form(s) of food assistance (examples: SNAP, WIC, CSFP, or SFMNP)?

Yes

No

Please list the form(s) of food assistance below:

Thanks for submitting!