Enter Agency InformationLocation*--- Select Location ---Aberdeen, SDBrookings, SDFort Dodge, IALeMars, IANorfolk, NEMarshall, MNMason City, IAMitchell, SDNorfolk, NEPierre, SDRapid City, SDSioux City, IASioux Falls, SDSpencer, IAStorm Lake, IAWatertown, SDWorthington, MNYankton, SDOtherSelect Sioux City Agency*Council on Sexual Assault & Domestic ViolenceCrittenton CenterDismas CharitiesGoodwillHaven HouseHope Street of SiouxlandIowa Vocational Rehabilitation ServicesIowaWorks - Title IJackson Recovery Women and Children’s CenterMary Treglia Community HouseMercy HousingNortheast Nebraska Community ActionONCRT (Omaha Nation Community Response Team)Ponca Tribe of NebraskaRural Domestic Violence ProgramSalvation ArmySanford CenterSioux City VASiouxland Community Health CenterSiouxland District Health Dept.Siouxland Mental HealthTSI (Transitional Services of Iowa)Winnebago Tribal Social ServicesWomen AwareOtherSelect Aberdeen Agency*Dept. for Social ServicesGoodwillSafe HarborTanf (Dept. of Labor)OtherSelect Watertown Agency*GoodwillOtherSelect Storm Lake Agency*Family Crisis CentersGoodwillIda Services Inc./IdaWORKSOtherSelect Mitchell Agency*GoodwillOtherSelect LeMars Agency*GoodwillOtherSelect Fort Dodge Agency*GoodwillOtherSelect Brookings Agency*Brookings DLRBrookings DSS OfficeGoodwillOtherSelect Pierre Agency*American Red CrossCapital Area CounselingDepartment of Social ServicesGoodwillJob ServiceMissouri ShoresOahe IncPierre Area Referral ServicesThe Corner Stone (Vetern Service)OtherSelect Mason City Agency*BeJe Clark Residential CenterCounty Social ServicesCrisis Intervention ServiceGoodwillIowa WorksNorthern Lights Alliance for the HomelessPrairie Ridge Integrated Behavioral HealthcareOtherSelect Yankton Agency*Department of Corrections, ParoleDepartment of LaborDepartment of Social ServicesGoodwillOtherSelect Spencer Agency*Abben Cancer Center of Spencer HospitalGoodwillIowa Workforce Development -Iowa WorksUpper Des Moines Opportunity, Inc.OtherSelect Norfolk Agency*GoodwillNebraska Dept. of LaborNENCAPRescare Work Force ServicesOtherSelect Marshall Agency*GoodwillMN Workforce CenterUnited Community ActionWRAPYellow Medicine Family ServicesOtherSelect Worthington Agency*GoodwillMN Workforce CenterUnited Community ActionWRAPYellow Medicine Family ServicesOtherSelect Rapid City Agency*BMS - Full CircleCommunity Alternatives of the Black HillsDepartment of LaborGoodwillHope CenterLove, IncPennington County Health and Human ServicesRebound/Pennington County Health and Human Services/Care CampusRural America InitiativesUnited Sioux Tribes of South Dakota Development CorporationVolunteers of AmericaWestern Resources for Independent LivingWorking Against Violence Inc.OtherSelect Sioux Falls Agency*Center of HopeChildren’s Home SocietyGlory HouseGoodwill East 41stGoodwill Job CenterGoodwill KiwanisGoodwill S. NortonHeartland HouseS.D. Department of Veteran AffairsSalvation ArmySanford HealthSioux Falls HousingSoutheastern Directions for Life- Community Support ServicesThe Community OutreachVocation RehabilitationOtherEnter Agency Name* Voucher Recipient InformationRecipient's First Name* Recipient's First Initial of Last Name* Dollar Amount*Email (optional)Enter email address to receive a copy of this form.