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  • Application for COVID-19 related Financial Assistance

    This form is an application for financial assistance for Rent and Utilities for people who have had a job loss or hours reduction due to Covid-19 only. You must fill out this form in its entirety, select an appointment time, and click submit. Partial submissions will not be counted.

  • Personal Information

    Please fill out this section completely.
  •  /  / Pick a Date
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  • Covid-19 Assistance Information

    Please fill out the information below so we can better assist you.

  • General Financial Information

    To better qualify you, we need some information about your family financial situation.

  • Other Circumstances

    In the space below, please describe any other reasons or circumstances (past, present, or future) that you feel increase your qualification and/or need for financial assistance.

  • Conditions Upon Acceptance

  • Terms & Conditions:
    If you qualify for financial assistance from St. Vincent de Paul Society for Covid-19 relief, it is your responsibility to do the following before any financial distributions have been made:

    1. Before your scheduled appointment, provide SVDP all required documents including copies of:

    • Photo ID
    • Proof of Address
    • Proof of Income (pay stubs, bank statement, SSI/TANF statement)
    • Proof of Covid-19 related job loss or hours reduction (statement from your employer, pay stubs showing drop in hours/pay)
    • Bill to be paid, including amount due, account number, and address where we send payment

      You may upload your documents below, or send to SVDP via picture or scan and send by text message to 574-387-3209, via email at svdpteamheat@gmail.com , or via US mail to:

      St. Vincent de Paul Society
      attn: Financial Assistance
      520 Crescent Avenue
      South Bend, IN 46617

    It is your responsibility to make copies of your own documents.  
    SVDP will not copy your documents for you.

    2. Meet via phone or video conference with a SVDP team member or volunteer to discuss your case.  You will receive an appointment time and date after your data on this form is verified.  SVDP will attempt to contact you twice during your appointment time.  If you do not answer the phone by the second call, your application will be voided and you will need to reapply.

    3. Understand that some of the programs administered by St. Vincent de Paul are federal programs and may disqualify you from receiving assistance from other federal Covid-19 relief program funding.  

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  • Consent for Services

    Please sign below

  • I understand that the St. Vincent de Paul Society of St. Joseph County, Inc. (SVDP), may need to obtain and/or share information about me to establish my eligibility for services such as client choice pantry, home food delivery, food and clothing vouchers, rent and utility assistance, and any other SVDP program for which I apply.  I also understand that SVDP may obtain and/or share information about me through written, oral, and electronic communication.

    By signing my name below:

    • I authorize SVDP to obtain information about me from other agencies, organizations, and individuals for the limited purpose of making decisions about my elegibility for and participation in one or more SVDP programs.

    • I authorize SVDP to share information about me from other agencies, organizations, and individuals for the limited purpose of making decisions about my elegibility for and participation in one or more SVDP programs.

    • I understand that my authorization will remain effective from the date I sign below until I withdraw this authorization in writing.

    • I understand that I may withdraw this authorization at any time by delivering a written notice to the Executive Director of SVDP, and that my withdrawl will be effective when SVDP receives it.

    • I understand that SVDP will handle my personal information in compliance with all applicable laws.

    By signing my name I affirm that I have read this release, understand it, and sign it voluntarily.

  • Clear

  • Select your appointment time

    You will be called by St. Vincent de Paul at your scheduled appointment time. (times are set to military time so 13:00 is 1:00pm)

  • Click submit to finish your application

    Your application will NOT be saved and your appointment will NOT be scheduled if you do not click the submit button.
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