Application for Rent, Utility & ER Food
HER Faith Ministries is partnering with Truist Bank to provide rent, utility & emergency food assistance to "working women with children" who earn a low to moderate income and may also receive some government assistance. Applications are processed January thru March (coldest months) and July thru September (hottest season). Please note that this grant targets a specific group of applicants who meet the qualifications stated above. If you are a working mother who is seeking "other assistance," (not rent or utilities), you should complete the application and provide details on what "other" help you are requesting. Incomplete applications will not be processed. Please allow 2 to 3 weeks to receive a reply. We regret that we are not able to assist all applicants. "If you do not meet the stated criteria, our Ministry will not be able to assist you."
Name
*
First Name
Last Name
DATE OF BIRTH
-
Month
-
Day
Year
Date
Address
*
Street Address
Apartment number
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Cell Phone Number
*
Please enter a valid phone number.
Alternate Phone Number
Please enter a valid phone number.
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)
*
Please Select
1-3 children
4-6 children
More than 7 children
What type of benefits or government assistance do receive?
Food Stamps
SSI
TANF
Disability
Child Support
Alimony, Rental Income, Other
Date of application. [PLEASE DO NOT COMPLETE A 2ND APPLICATION. IT WILL BE DELETED!]. Incomplete applications will NOT be processed.
-
Month
-
Day
Year
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?
-
Month
-
Day
Year
Date
Do you currently have a job? If no, why not?
Please check all income sources that apply. I receive:
Income from Employment
SNAP, TANF, SSI, or Disability
Rental Income or Child Support
Income 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.
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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.
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Please upload a valid photo ID. Your Application WILL NOT be processed, if no proper ID is included here.
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ADMINISTRATIVE NOTES (do not write in this space)
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