90 Day Rental or Mortgage or Utility Assistance
One (1) request for assistance per household every 90 days from date of last assistance. Maximum allowable amount for 90 Day Assistance is up to $200 on the current amount.
Application Information
Name
*
First Name
Last Name
CDIB#
*
Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Physical Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Date of Birth
*
-
Month
-
Day
Year
Date
Choose one:
*
Rental/Mortgage Assistance
Utility Assistance
Attach and submit a copy of all pages of current lease or mortgage statement with application each time you apply. We do not accept eviction notices, note to quit, or deposit paperwork. ***Photographs of the documents will not be accepted***
Browse Files
Required for rental/mortgage assistance
Cancel
of
Attach and submit all pages of current utility bill and we pay current amount only. We do not pay on street lights. No past due bills, final bills, or disconnect notices accepted. *** Last day to submit a bill is the day bill is due *** ***Photographs of the documents will not be accepted***
Browse Files
Required for utility assistance
Cancel
of
Submit
Should be Empty: