Phone 814-670-0838

Outer Limits Verification Form

Thank you for your interest in the Outer Limits Program.
Due to being a Venango County Grant, this program is ONLY available to Venango County residents. 

This form will help verify your child's eligibility for aid through the Outer Limits Program.
Please fill in the information below and our Outer Limits Coordinator will follow up with you. 

Do you live in Venango County?
First Name *
Last Name *
Child's Gender
First Name *
Last Name *
Relationship to Child
Is the child/family receiving:
Is the child a U.S. Citizen or qualified alien?
If yes, indicate documentation source:

In order to be eligible, a child/family's gross income may not exceed 400% of the Federal Poverty Guidelines for the family unit size.
For example, a family of 4 can make less than $106,000 annually (gross income). 

(Family unit includes biological, adoptive or step-parents, specified relatives, or non-relative court designated legal custodians and full, half, and/or adopted siblings living in the home under the age of 18 plus the child applying). 

What is your family size?
What is the child/family's annual gross income?
Is the child between the ages 8-17?
Is the child living in the home of a parent, other adult specified relative or a court designated legal custodian?
Please use this space to tell us how you heard about us. Thank you in advance for taking the time to fill this out! We appreciate your help.
2335 West 38th Street
Suite 1
Erie, PA 16506
Phone 814-670-0838

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