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CityLink Evening Service - CDBG Eligibility Application

  1. CityLink-Logo2016-BlueAngle

  2. CityLink Evening Service - Community Development Block Grant (CDBG) Eligibility Application

    The Community Development Block Grant (CDBG) funds CityLink's Evening Service to provide transportation for individuals to get to and from work or job training and school programs.

  3. Client Information

  4. Household Information

  5. Number of Adults

  6. Number of Children (18 years old or younger)

  7. Can client be classified as someone's dependent?*

  8. Does client have dependents (age 18 or younger) of their own in the household?*

  9. Is client head of the household?*

  10. Single Parent?*

  11. Income Information

  12. Employment, Training, School-Service Needs

  13. CDBG Income Level Eligibility Table

    Income Falls within the established limits for participation in the CDBG program as indicated below:


    1 Person 2 Person 3 Person 4 Person 5 Person 6 Person 7 Person 8 Person
    30% of Median 12,200 16,020 20,160 24,300
    Very Low Income 20,300 23,200 26,100 29,000 31,350 33,650 36,000 38,300
    Low Income 32,500 37,150 41,800 46,400 50,150 53,150 57,550 61,250

  14. By signing below I affirm that I have received information concerning the rules, regulations, and procedures related to use of the CityLink Special Services and agree to follow the established guidelines to the best of my ability.


    I confirm that the information that I have provided to CityLink on this form is true and correct. I understand that this information is being used to determine my eligibility for participation in the Community Development Block Grant (CDBG) transportation program and that any information that I provide, including household income information, is subject to verification.

  15. Leave This Blank:

  16. This field is not part of the form submission.