Hardship Assistance Application

Please fill out this form accurately. This helps us understand your situation and process your request as quickly as possible. We are here to help.

Applicant Information

First Name *

Last Name *

Email Address *

Phone Number *

Please select one of the following. *

Payment Handle (for aid disbursement)

Please provide at least one handle so we can send assistance directly to you if approved.

Zelle (Phone or Email)

CashApp ($Cashtag)

Detrimental Threat Selection

Please select the primary immediate threat you are currently facing. (Select one)

Housing Issues

Transportation Issues

Childcare Assistance

Gas / Heating / A/C Shut-off

Emergency Food Assistance

Elderly / Widow Assistance

Provide Documentation

Please select a threat in Step 2 to see required documentation.

Brief Explanation

Important: Your explanation must be specific — not vague. Include exact dates, deadlines, and amounts due so we can fully understand the urgency of your situation so we may be able to accommodate your request as quick as possible.

Please briefly explain your situation and how this aid will help you recover. *

By submitting, you agree that all information provided is truthful and accurate to the best of your knowledge.