CCA LEAP Application 

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Request for Assistance

If you have already applied for financial assistance through SMILE Community Action Agency, you must continue the application process with them. Applications originally submitted to SMILE will not be processed by Catholic Charities of Acadiana. 

While completing this form, if you have any questions, please complete as much as you can and we will contact you using the email address you provide. 

If you are in need of financial assistance with rent or utilities, please complete the form below. It is important to answer each question so that we can better serve you. 

Documents you will need: 
Copy of a valid ID
Copy of Landlord Invoice and Landlord W9. Click to download.
Copy of your lease
Copy of Utility Bill for each month for which you are requesting payment
Copy of insurance cards for children and/or all dependents 
Copy of an eviction notice
Income Source Documents for all adult members of your household:
  • 4 Consecutive Pay Stubs or a Signed Letter on Employer Letterhead
  • Award Letter for Unemployment/Bank Statement Showing Deposit
  • Social Security/SSI/SSDI Award Letters
  • Self-Attestation of Income/No Income
Should we need additional information a service coordinator will contact you at the number provided in your application. Submitting an application does not guarantee assistance. 

Grievance Procedure

When participants of the Catholic Charities of Acadiana, Inc. have a grievance concerning a staff member(s) involved in the services and/or housing they are receiving, they may request a meeting with the staff member’s immediate supervisor. If the supervisor is unavailable and/or the grievance is not resolved, the participant will be referred to the individual listed below.

Kimberly James Boudreaux
Chief Executive Officer
P.O. Box 3177
Lafayette, LA 70502

Catholic Charities of Acadiana, Inc. will make every effort to ensure that all participants are aware of and understand the grievance procedure upon receiving service and/or housing from this agency.
All complaints and concerns voiced by participants will be treated with respect, and will be handled fairly and justly, with no retaliation toward any participant making a complaint.

By proceeding with this application I acknowledge that I have been made aware of and understand the grievance procedure for participants of Catholic Charities of Acadiana, Inc.

Screening Questions

Applicant Contact Details

The applicant must be the leasee and/or primary person on utility bill. 
Contact Details

Assistance Requested Details

Rental Assistance Information

Utility Assistance Information
For Multiple Utility Bills please click "Add another response" at the bottom of this section.

Additional Household Members

Household Member Contact Details

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