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By completing and submitting the following application you are “self-certifying” that you or someone in your household have been directly or indirectly affected by the Coronavirus pandemic. “Affected” could mean one or more of the following: someone in the household has qualified for unemployment benefits, experienced a reduction in household income, incurred significant cost, or experienced other financial hardship due directly, or indirectly to the novel Coronavirus disease (COVID 19).

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