Enter Agency InformationLocation*--- Select Location ---Aberdeen, SDNorfolk, NEMarshall/Worthington, MNSioux Falls, SDSioux City, IASpencer, IARapid City, SDOtherSelect Sioux City Agency*Council on Sexual Assault & Domestic ViolenceCrittenton CenterDismas CharitiesHaven HouseJackson Recovery Women and Children’s CenterMary Treglia Community HouseMercy HousingONCRT (Omaha Nation Community Response Team)Ponca Tribe of NebraskaRural Domestic Violence ProgramSanford CenterSioux City VASiouxland District Health Dept.TSI (Transitional Services of Iowa)Winnebago Tribal Social ServicesWomen AwareOtherSelect Aberdeen Agency*Dept. for Social ServicesSafe HarborTanf (Dept. of Labor)OtherSelect Spencer Agency*Iowa Workforce Development -Iowa WorksAbben Cancer Center of Spencer HospitalOtherSelect Norfolk Agency*Nebraska Dept. of LaborRescare Work Force ServicesOtherSelect Minnesota Agency*Yellow Medicine Family ServicesWRAPMN Workforce CenterUnited Community ActionOtherSelect Rapid City Agency*Community Alternatives of the Black HillsDepartment of LaborPennington County Health and Human ServicesRebound/Pennington County Health and Human Services/Care CampusRural America InitiativesVolunteers of AmericaOtherSelect Sioux Falls Agency*Center of HopeChildren’s Home SocietyGlory HouseGoodwill East 41stGoodwill Job CenterGoodwill KiwanisGoodwill S. NortonHeartland HouseS.D. Department of Veteran AffairsSalvation ArmySioux Falls HousingThe 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.