Basic Needs Form

LEAF Basic Needs Application
LEAF – Lyons Elevating All Fund partners with households in the Greater Lyons area by providing short-term financial support and resource navigation to help strengthen stability and wellbeing. Financial assistance is paid directly to vendors and may help cover essential expenses such as rent, utilities, medical bills, vehicle repairs, and other critical needs during challenging times.

If you have any questions about this application please email: kim@leaflyons.org

Please review our Guidelines here before applying.
Where do you live?
LOCATION
Which of the following applies to you?
Sorry, it looks like you are outside our service area.

Please take a look at these resources:

Sister Carmen: Lafayette, Louisville, Superior, Erie - Call 303-665-4342
OUR Center: Longmont, Lyons, Niwot, Allenspark, Frederick, Firestone, Mead (St Vrain School District) - Call 303-772-5529
Broomfield FISH: Broomfield - Call 303-465-1600

Basic Information
Name (As shown on your ID)

First NameLast Name
Preferred name (if applicable)
Please upload a photo ID (drivers license or anything that identifies you with name/photo)

Cancelof
Date of Birth:

MonthDayYear
Date
What is your current physical address?

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How long have you lived at the above address?
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
What is your email address? (If you do not have an email write Noemail@noemail.com)
How many people (including yourself) live in your household?
Please list the names and ages of everyone living in your household (including yourself)
What is your monthly household income?

LEAF Basic Needs Application