Emergency Living Assistance

Finding Stability Through Crisis

We help families in crisis find stability and rebuild their lives by providing emergency fuel, rental, and utility assistance. Priority is giving to clients who:

Have received utility shut-off notices or court summons for eviction
Live in public housing and have been served with a notice to quit letter from the property manager, property attorney, or constable
Are in need of emergency fuel assistance
Need to move due to safety or emergency reasons (i.e., domestic violence, moving from shelter to stable housing, etc.)

For potential assistance, please fill out and submit the form below as accurately as possible.

Emergency Living Assistance

Name(Required)

First Last

Email(Required)

Enter Email Confirm Email

Phone Number:(Required)

Race:(Required)

Address:(Required)

City(Required)

County(Required)

Language:(Required)

Marital Status:(Required)

Veteran(Required)

Yes

Ethnicity:(Required)

Family Composition(Required)

(Everyone Living in the house)

Full Name

Race

Gender

DOB

Relationship to HOH

Sources of Income:

Include ($) amount everyone's income in the household over the age of 18. Please fill out all sections. (Type N/A if not applicable.)

Employment(Required)

How much do you receive monthly from employment.

Unemployment(Required)

How much do you receive monthly from unemployment.

Food Stamps(Required)

How much do you receive monthly from Food Stamps.

Child Support(Required)

How much do you receive monthly from Child Support.

SS Disability(Required)

How much do you receive monthly from SS Disability.

Pension(Required)

How much do you receive monthly from your Pension.

SSP(Required)

How much do you receive monthly from your SSP.

SSI(Required)

How much do you receive monthly from your SSI.

Other:(Required)

Please specify any other sources of income.

Other:(Required)

Please specify any other sources of income.

MONTHLY EXPENSES

Only include ($) amount of monthly expenses - Enter an ($) amount representing your monthly expenses, not the amount owed. Monthly expenses should include everyone over 18's expenses in the household. Please fill out all sections and type N/A if not applicable

Rent/Mortgage(Required)

How much do you spend monthly on Rent/Mortgage?

Rental Insurance(Required)

How much do you spend monthly on Rental Insurance?

Utilities(Required)

How much do you spend monthly on Utilities?

Vehicle Loans(Required)

How much do you spend monthly on Vehicle Loans?

Vehicle Insurance(Required)

How much do you spend monthly on Vehicle Insurance?

Health Insurance(Required)

How much do you spend monthly on Health Insurance?

Legal Fees(Required)

How much do you spend monthly on Legal Fees?

Transportation(Required)

How much do you spend monthly on Transportation

Groceries(Required)

How much do you spend monthly on Groceries?

Telephone(Required)

How much do you spend monthly on Telephone?

Internet(Required)

How much do you spend monthly on Internet?

Cable(Required)

How much do you spend monthly on Cable?

Day Care(Required)

How much do you spend monthly on Day Care?

Clothing(Required)

How much do you spend monthly on Clothing?

Credit Cards(Required)

How much do you spend monthly on Credit Cards?

Other Expenses(Required)

How much do you spend monthly on Other things?(specify)

Other Expenses(Required)

How much do you spend monthly on Other things?(specify)

Other Expenses(Required)

How much do you spend monthly on Other things?(specify)

SERVICES REQUESTED(Required)

Rent

Mortgage

Utilities

Other

Cause of Need(Required)

Please explain why assistance is required currently. Please indicate the event that caused this request. Please give as much details as you can.

Would you be willing to participate in an anonymous interview with Catholic Charities Marketing and Communications Department?(Required)

Yes

Please upload any files pertaining to your request.

Max. file size: 128 MB.

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Family & Youth Services

Basic Needs

Refugee & Immigrant Services

Adult Education & Workforce Development

Emergency Living Assistance

Finding Stability Through Crisis

Emergency Living Assistance

Sources of Income:

MONTHLY EXPENSES

Find Out How You Can Help

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