SOP_NUMBER: 215.21-att-1
TITLE: Center Indigent Loan Application
DIVISION: Facilities
TOPIC_AREA: 215 Policy-Transitional Center
EFFECTIVE_DATE: 2020-01-23
WORD_COUNT: 145
POWERDMS_URL: https://public.powerdms.com/GADOC/documents/563272
URL: https://gps.press/sop-data/215.21-att-1/

SUMMARY:
This form allows indigent residents at transitional centers to request emergency loans for essential needs such as hygiene items, laundry, phone calls, transportation, stamps, and other verified critical needs. Approved loans are repaid through deductions from the resident's next paycheck, and residents must use funds only for their stated purpose. The business manager must certify the resident's indigent status before approval by the superintendent.

KEY_TOPICS: indigent loan, transitional center, resident loan application, emergency financial assistance, laundry expenses, hygiene items, phone calls, transportation costs, loan repayment, paycheck deduction, critical needs, resident finances

ATTACHMENTS:
  1. Center Indigent Loan Application
     URL: https://gps.press/sop-data/215.21-att-1/
  2. Room and Board Waiver Request
     URL: https://gps.press/sop-data/215.21-att-2/
  3. Paycheck Procedure, Search Fee, and Positive Alcohol_Drug Test Fee Agreement
     URL: https://gps.press/sop-data/215.21-att-3/

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FULL TEXT:
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SOP 215.21
Attachment 1

1/23/20


**CENTER INDIGENT LOAN APPLICATION**

NAME OF RESIDENT ______________________________________________________________

I request a loan in the amount of $ _____________ for the following reasons:

_____ Laundry Expenses Amount $ ______

_____  Hygiene Items Amount $ ______

_____  Phone Calls Amount $ ______

_____ Transportation Costs Amount $ ______

_____ Stamps Amount $ ______

_____ Other verified Critical Needs Amount $ ______

Specify Need:  ___________________________________________________________

Total Requested:   _______________

I understand that. If approved, the amount borrowed will be deducted from my next paycheck. Further, I
will only use the funds for the purpose designated and understand that Center Staff may request evidence of
how the funds were spent.

________________________________________ _________________
COUNSELOR’S SIGNATURE DATE

________________________________________ _________________
RESIDENT’S SIGNATURE DATE

R&B Arrears _______  Account Balance ________ Funds Clear ________ On Hold ________

I certify that this resident is indigent and qualifies for an indigent loan.

________________________________________ ______________
BUSINESS MANAGER/DESIGNEE DATE

**______________________________________________________________________________________**

APPROVED
DISAPPROVED: ___________________________________ ______________
SUPERINTENDENT DATE


Retention Schedule: Upon completion, this form shall be retained locally for three (3) years and after a
fiscal audit is completed, shall be destroyed.