COVID-19 Assistance Application

Application to receive a grant from the COVID-19 Relief Fund through Catholic Charities and Diocese of Des Moines.
  • Individual Information

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    Please enter a number from 1 to 20.
  • Please enter a number from 0 to 20.
  • We encourage you to keep communicating with your providers.
  • ADDITIONAL RESOURCES: Catholic Charities Food Pantry: 1815 Hubbell, Des Moines | Call 211: referrals to other services via United Way.
  • Funding Request

  • Payment will be made directly to an individual via a prepaid VISA card – one payment per street address allowed.
  • Permission to Share

  • Signatures

  • MM slash DD slash YYYY