UCAN Client Application

Who is UCAN?

UCAN is an ecumenical ministry that provides financial assistance to qualified individuals and families to help them through a critical or emergency situation. We serve clients in the following zip codes: * 21030 * 21031 * 21071 * 21093 * 21111 * 21131 * 21152
Welcome to the UCAN Application Portal!

We are having difficulty attending to online applications and would appreciate it if you could visit our office for personalized attention during our office hours.
UCAN office hours

Wednesday and Friday - 10AM-1PM
Location

40 Church Lane * Cockeysville * Maryland * 21030 - However, see below if you are unable to visit our office during our office hours.
Alternative to Visiting UCAN

If you live in one of UCAN's zip codes and are unable to visit us during our office hours (10AM-1PM on Wednesdays and Fridays), please provide the information asked below and one of our volunteers will contact you. (Please be patient.)
21030 * 21031 * 21071 * 21093 * 21111 * 21131 * 21152

zip codes served by UCAN
Which Zip Code do you reside in?*
If you live elsewhere please consult www.211.org for resources in your area.
Date

MonthDayYear
Client Information
First Name
Last Name
Street address
Street address line 2
Name of Apartment Complex, if applicable
(e.g., Deertree, Fox Chase)
City
State
Zip code
Phone Number

Area CodePhone Number
E-mail address*
Date of birth

MonthDayYear
Date
First Visit?

Yes
Type of Identification Document
ex.] Driver's License, State ID card
Last 4 digits of SSN
Upload Identification Document

Browse Files
ex.] Driver's License, State ID card Cancelof
Household Members

(other people who live with you)
Single adult with children living with you?

Yes
Other adult(s) living with you?

Yes
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Type of Assistance Needed
Please upload a copy of your eviction notice (or BGE turn-off notice)

We need a copy of the notice before we can offer assistance.
Browse Files
ex.] Eviction Notice, Utility Turn-off Notice Cancelof
If you have a large outstanding balance we suggest you seek funding from multiple sources. Please use the following section to let us know what amounts other individuals/organizations are willing to offer:

PROMISE OF OTHER ASSISTANCE

The outstanding balance on the bill I'm seeking assistance with is   $ .

I have obtained a promise of assistance in the amount of $from the following person   First Name   Last Name.

I have obtained a promise of assistance in the amount of $   from the following organization   name of organization.

I have obtained a promise of assistance in the amount of $   from the following organization   name of organization.
Additional information you'd like us to know ...
By signing below, I: 1) Consent to UCAN referring my application to other agencies who may be able to assist with my needs, and 2) That information I have given to UCAN may be verified with the Baltimore County Department of Social Services or other agencies.
Client Signature

Clear
What you can expect from UCAN (please be patient - volunteers are working two days per week [Wednesdays & Fridays] for the foreseeable future):

You should receive:
1. Immediate confirmation when you submit this JotForm
2. A follow-up email/phone call from a UCAN Volunteer to discuss your situation and if UCAN can help. (Please be willing to answer calls from our office number - 410-628-2102 or "443" numbers.)
For office use only
Should be Empty:

Who is UCAN?

Welcome to the UCAN Application Portal!

UCAN office hours

Location

Alternative to Visiting UCAN

21030 * 21031 * 21071 * 21093 * 21111 * 21131 * 21152

If you live elsewhere please consult www.211.org for resources in your area.

Household Members

Please upload a copy of your eviction notice (or BGE turn-off notice)

By signing below, I: 1) Consent to UCAN referring my application to other agencies who may be able to assist with my needs, and 2) That information I have given to UCAN may be verified with the Baltimore County Department of Social Services or other agencies.