Assistance Application
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
What are you needing help with?
What amount are you seeking for assistance?
What caused this need?
Please give as much information as possible
Are you currently employed?
Yes
No
If so, where are you employed?
Have we helped you within the last 12 months?
How did you hear about us?
Upload your ID
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Upload your bill (if applicable)
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I understandthat funds for benevolence are extremely limited and that my application may bedenied because of lack of funds or if the assistance needed is of a long-termnature. Only temporary, or short term, needs of 45 days or less will beconsidered. I further understand that any assistance that may be provided is at the discretion of the CFMC staff and is made only after reviewing my application and a possible interview.
I Agree
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