Application for Assistance

Application for Assistance

Application for Rent, Utility & ER Food

To Applicants: The rent and utility assistance program through HER Faith Ministries serves women with school-age children living in the home at the time of the application. The applicant must be employed and meet the required "low to moderate" income range. If you are applying for rent assistance, a copy of your lease and a letter or notice of impending eviction must be provided. If you are applying for utility assistance, you must provide a "cut off" notice from MLGW. Applications are processed July thru September and January thru March. Please note that this grant targets specific applicants: "working women with children." If you do not meet the stated criteria, we will not be able to assist you at this time. If you are a working mother who is seeking "other kinds of assistance," (not rent or utilities), you should complete the application and provide details on what "other" help you are requesting. Note: Incomplete applications will not be processed. Applications without proper ID will not be processed. Please allow 2 to 3 weeks to receive a response "by email" only. Finally, this is an "assistance" grant which means it may not pay the full amount that you owe. For additional help, you may want to apply to MIFA, CSA, 901Home or other agencies. Links to their applications are provided on our website.
Name*

First NameLast Name
DATE OF BIRTH

MonthDayYear
Date
Address*

Street Address

Apartment number

CityState / Province

Postal / Zip Code
Email*
example@example.com
Cell Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Alternate Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
How many of your own children under the age of 18 are living in the household with you at this time? (You must have children to qualify)*
What type of benefits or government assistance do receive?

Food StampsSSITANFDisabilityChild SupportAlimony, Rental Income, Other
Date of application. [PLEASE DO NOT COMPLETE A 2ND APPLICATION. IT WILL BE DELETED!]. Incomplete applications will NOT be processed.

MonthDayYear
Date
Please describe the assistance you are needing. Example: Help paying rent or help paying utility bill. Help securing food, clothing, etc.*
What is the reason that you are needing assistance? [Please explain]
Have you applied to (CSA) Community Services Agency, MIFA or 901Home? Yes or No, Please explain. YOU MUST APPLY to one or all of these agencies before our Ministry can consider you application.
Last date that you worked?

MonthDayYear
Date
Do you currently have a job? If no, why not?
Please check all income sources that apply. I receive:

Income from EmploymentSNAP, TANF, SSI, or DisabilityRental Income or Child SupportIncome from Other sources(Please note that the income that you receive may not disqualify you from receiving help. However, failing to disclose all income sources truthfully will definitely disqualify you from uture help.
Please provide proof of income (2 recent check stubs. Proof of government assistance such as SSI letter, EBT card, Benefits approval letter, TANF, child support, etc.

Cancelof
What is your income level?

0-$1999 month$2,000 - $2999 month$3000 - $3,999 month$4000 or above month
If you are asking for Utility Assistance, YOU MUST upload an MLGW CUTOFF NOTICE with your name on it. If you are applying for Rent Assistance, please upload a document which reflects a threat of eviction/rent demand letter with your name on it.

Cancelof
Please upload a valid photo ID. Your Application WILL NOT be processed, if no proper ID is included here.

Cancelof
ADMINISTRATIVE NOTES (do not write in this space)
Should be Empty: