• Emergency Financial Assistance (EFA) Application

    Emergency Financial Assistance (EFA) Application

  • Date of Birth*
     - -
    2 digit month, 2 digit day, 4 digit year
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  • Format: (000) 000-0000.

  • Please select which zip code you live or work in.*
  • How did you hear about BEAM?*
  • What kind of support are you looking for? (Check all that apply)*

  • Home Address

  • Tell Us About Your Hardship

    BEAM defines a hardship as a confirmed event or situation that happened within the past 3–6 months and has made it hard for a household to pay rent, mortgage, or utilities. This may put the household at risk of eviction, foreclosure, or having utilities turned off.
  • Please select which option best describes your type of hardship.*
  • When did this hardship begin?*
     / /
    2 digit month, 2 digit day, 4 digit year
  • Is this hardship ongoing or temporary?*

  • Please upload at least one document supporting your hardship.

    Screenshots and Envelopes WILL NOT BE ACCEPTED.
    Any photos submitted must be clear and easy to read.

    Examples of documents that will be accepted are:

    • Job termination letter
    • Reduced hours on paystubs
    • Unemployment benefits approval
    • Medical bill receipt
    • Medical leave paperwork
    • Hospital discharge paperwork
    • Car repair receipt
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  • Income Information

  • Please select all sources of your current household income.*

  • Please upload documentation as proof of income.

    Screenshots and Envelopes WILL NOT BE ACCEPTED.
    Photos of documents must be clear and easy to read. 

    Examples of documents that will be accepted are:

    • Paystubs for the past 30 days
    • Social Security award letter
    • Unemployment benefits statement
    • Pension or retirement statement
    • Child support and/or alimony documentation
    • Offer letter from future employer
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    • Utility Assistance 

    • Utility Assistance

    • Your PAST DUE bill should show METER DATA AND BREAKDOWN OF CHARGES.

      Screenshots and Envelopes CANNOT BE ACCEPTED.
      Reminder Notices CANNOT BE ACCEPTED.
      Shutoff Notices CANNOT BE ACCEPTED.

      Photos of documents must be clear and easy to read.

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    • Rental Assistance 

    • Rental Assistance

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    • Mortgage Assistance 

    • Mortgage Assistance

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    • By submitting this application you agree to receive recurring messages from BEAM, Reply STOP to Opt out. Reply HELP for help. Message frequency varies. Message and data rates may apply. Carriers are not liable for delayed or undelivered messages. No mobile information will be shared with third parties/affiliates for marketing/promotional purposes. All OPT-IN requests include text messaging originator opt-in data and consent; this information will not be shared with third parties.

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