Financial Assistance Application

Financial Assistance Application

Housing Related Support
PLEASE READ CAREFULLY

You may be eligible for assistance with past-due rent, mortgage payments, utility bills, or move-in costs such as security deposits, first/last month’s rent, furniture, household supplies, and other approved housing-related incidentals. Funds are available monthly. Assistance is based on available funds.

** This application is limited to one household at a time.**

If you are looking for Transitional Housing/Sober Living/Supportive Housing at one of our recovery homes, please fill out the following application instead: Sprout Sober Living Resident Application

Purpose of Funds
- These funds are designated for housing support and items directly related to providing safe and stable housing for individuals in recovery.
- Provide rental assistance and housing supports to Floridians living with a Substance Use Disorder (SUD) or in Remission from an Opioid Use Disorder (OUD)
- Promote continuity of care and long-term housing stability
- Support individuals as they achieve their recovery objectives
- Reduce reliance on shelters, hospitalizations, and involvement with the criminal justice system
Funds received under this program are time-limited and are intended to **supplement—not replace** other state or local funds used to start, maintain, or expand Recovery Housing and Housing Support services.

Eligibility

UPDATE: At this time, only residents residing in the following counties are eligible to receive funding: Manatee, Sarasota, Hendry, Charlotte, Lee, and Collier.

To qualify, you must be:
- A Florida resident aged 18 or older, and
- Living with or in Remission from a Substance Use Disorder (SUD) or an Opioid Use Disorder (OUD), and
- At risk of homelessness or currently homeless
Required Documentation

Copies of the following documents will be required. We cannot approve or continue with your application without this proof:

Proof of Age & Residency:
- Photo ID for yourself (Driver's License, State ID, etc.) OR
- Voter registration card, OR
- Other valid government-issued ID
Proof of SUD/OUD Status:

Letter from a licensed treatment provider, recovery center, medical professional, certified peer support specialist, or probation officer. **No clinical diagnosis, medical records, or detailed personal history is required**

For Rent or Mortgage Assistance & Utility Payments:

The Bill You Need Help With (An official copy of the utility bill, or your lease, and an eviction notice or past-due letter from your landlord, mortgage statement, etc.)
ATTESTATION*

I, the applicant, understand that all questions must be answered truthfully & completely. Incomplete applications may not be considered for financial assistance.I, the applicant, understand that Sprout Recovery may contact any agency shared in this application to verify information submitted.I, the applicant, attest that I meet ALL the above eligibility criteria.

At this time, you do not meet the eligibility criteria for funds under this program.

If you need assistance, please dial 211 for United Way.

Thank you

Household Information

Please answer every question completely and accurately. Incomplete applications may not be considered for financial assistance.
Household Size (Total number of people, including applicant)*
If living in transitional housing, include only the applicant and any children.
Number of Children (under 18) in Household:*
Do you currently have income?*

YesNo
Total Monthly Household Income*
Income Source(s)*

EmploymentSSI/SSDI, TANF, SNAPUnemploymentOther

Rent or Mortgage Assistance

Please answer every question completely and accurately. Incomplete applications may not be considered for financial assistance.
Total Amount Past Due: $ *
How many months is this past due amount for?:*
Amount Requested from Us: $*
Name of Company/Landlord to be Paid *
Company/Landlord's Phone Number*
What type of housing is this? *

Permanent Housing (with rental lease/mortgage)Transitional Housing (no lease, structured environment, FARR Certified)Supportive Housing (with/without case management, FARR Certified)Other
Rent or Mortgage Assistance

Upload acceptable documentation
- Lease & a bill/statement
- Lease & eviction notice
- Mortgage statement
File Upload - Rental Assistance*

Uploading incorrect, incomplete, or unrelated documents will result in automatic withdrawal of your application.
Cancelof
Additional Assistance Request*

Utility AssistanceI have applied for everything I need right now, and I am ready to submit

Utility Assistance

Please answer every question completely and accurately. Incomplete applications may not be considered for financial assistance.
Utility Type*

ElectricWaterInternetPhoneOther
Utility Company Name*
Account Number: *
Name on Account:*
Total Amount Past Due ($)*
Amount to Stop Disconnection ($)
Amount Requested from Us: ($)*
Disconnection Date (if any):

MonthDayYear
Date
Utility Assistance

Upload acceptable documentation
- Bill/Statement
File Upload - Utility Assistance*

Uploading incorrect, incomplete, or unrelated documents will result in automatic withdrawal of your application.
Cancelof
Additional Assistance Request*

Eviction Prevention/Rent/Mortgage AssistanceI have applied for everything I need right now, and I am ready to submit

Applicant Certification and Release of Information
What steps, supports, or resources will help you maintain stable housing after assistance is provided?*
If you would like, you may share about your journey or current situation that you believe helps us better understand your need for support. (This is completely optional.)
By entering your name below, I, the applicant, certify that: * I meet all of the eligibility requirements listed on page 1 of this application.* All information provided in this application is true, correct, and complete to the best of my knowledge. I understand that providing false information will make me ineligible for assistance.* I understand that Sprout Recovery assistance is not guaranteed and is based on criteria and funding availability.* I understand that my application is not complete until all documents requested are submitted to Sprout Recovery.* I authorize Sprout Recovery to verify the information in this application. This may include contacting my landlord, the utility company, or a recovery program/treatment provider. * I authorize Sprout Recovery to share my information with other partner agencies or programs to coordinate services, referrals, and payments, if necessary.* I have reviewed by responses for accuracy. *
Please enter your full legal name above
Should be Empty:

Financial Assistance Application

Demographic Information

Recovery History

Household Information

Description of Financial Hardship

Move-In Assistance

Rent or Mortgage Assistance

Utility Assistance

Household Items Needed

Applicant Certification and Release of Information