Get Financial Assistance Request Form (page 1 Of 2)

Filling out the Financial Assistance Request Form is an important step in applying for support. This guide will provide you with clear, step-by-step instructions to help you complete the form online efficiently and accurately.

Follow the steps to fill out the form correctly.

1. Click ‘Get Form’ button to obtain the form and open it in the online editor.
2. Begin by entering your full name in the designated field. Ensure that you provide your legal name as it appears on official documents.
3. Next, input the date in the specified format. This date will indicate when you are submitting the request.
4. Fill in your complete address, including street address, city, state, and ZIP code. This information is vital for contact purposes.
5. Provide your phone number in the appropriate field. Ensure it is active so you can receive any follow-up communication.
6. Indicate the total number of individuals in your household, as well as the numbers under age 16 and over age 65.
7. Input the number of working individuals in your household and your total gross household income on a monthly basis.
8. Respond to the question about current governmental financial assistance. If you receive assistance, specify the agency and the amount received.
9. List your total monthly household expenses, including rent or mortgage, utilities, automobile payments, groceries, and any other miscellaneous expenses.
10. Indicate if you have received assistance from other non-profit agencies in the last three months, including the amount received.
11. Answer whether you have ever been denied assistance, providing a brief explanation if applicable.
12. Finally, write a brief description of your current need for financial assistance in the provided space.
13. Once you have completed all fields, review your entries for accuracy. Make any necessary corrections.
14. After confirming your information is correct, you can save changes, download, print, or share the completed form as required.

Begin your application process by filling out the Financial Assistance Request Form online today.