(All uploads required unless otherwise noted)
By submitting this application, I agree to the following terms and conditions set forth by Mozaic 501(c)(3):
I affirm that all information provided in this application is true, complete, and accurate to the best of my knowledge. I understand that providing false, misleading, or incomplete information may result in immediate denial or termination of assistance and may subject me to legal consequences.
I agree to provide valid, up-to-date supporting documentation, including but not limited to:
I understand that:
All assistance provided by Mozaic must be used exclusively for essential and basic living expenses as stated in this application, including but not limited
I understand and agree that:
If further support is needed beyond the initial 3-month term:
All information will be kept confidential and used solely for eligibility assessment and program coordination.
Mozaic reserves the right to approve, reduce, deny, or revoke assistance at any time, based on:
Mozaic operates in full compliance with federal, state, and local laws. Any behavior involving fraud, forgery, or document manipulation will result in immediate termination of aid and referral to legal authorities.
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