Screening Form for the Excluded Worker Fund | Columbia County Sanctuary Movement CRM

This is a screening tool and NOT an application. We are encouraging people to still fill out this form so we can work on ensuring you have the proper documentation to be able to apply if the fund opens again, as well as support anyone in the appeals process.

First Name *

Last Name *

Phone *

County *

Can we send you texts about relevant CCSM programs and immigration alerts? *

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This is a screening tool and NOT an application. We are encouraging people to still fill out this form so we can work on ensuring you have the proper documentation to be able to apply if the fund opens again, as well as support anyone in the appeals process.

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