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Apply for Emergency Assistance for Families

In order to qualify for Emergency Assistance, please answer the following questions:


Acknowledgement

This application is a result of a temporary loss of income or hours by at least 50% due to the current Coronavirus (COVID-19) outbreak.

I understand that in order to apply for this assistance,

  • I must have a child under the age of 18 or must be Pregnant (pregnancy verification must be provided if no child in household under age 18).

  • I must have been employed as of March 11, 2020, and must have experienced at least a 50% reduction of hours or loss of employment.

  • I must provide verification of available resources (checking and/or savings accounts). Verification of resources includes but is not limited to bank statements.

  • I must provide verification of temporary reduction in employment hours or temporary loss of employment. Verification of income includes but is not limited to check stubs, statement from employer, and/or unemployment compensation approval notice. Check stubs and/or statements from employer must include 2 weeks of income prior to loss of employment or reduction in hours. Self-employment must be verified by providing self-employment license (or any other proof of being self-employed) and most recent tax return filed or other documentation of reduction or loss of income (checking/savings accounts). I understand this application will be denied if I do not submit valid verifications with my application.

PLEASE FILL OUT ALL INFORMATION AND ADDITIONAL HOUSEHOLD MEMBERS AS ACCURATELY AS POSSIBLE, SUBMIT YOUR APPLICATION AND VERIFICATIONS ELECTRONICALLY.