LEAF Basic Needs Application

LEAF Basic Needs Application
LEAF - Lyons Elevating All Fund in Lyons, Colorado offers re-stabilizing financial grants and resource referrals to households in the Greater Lyons, Colorado area for basic needs that can include rent, utility assistance, medical bills, or transportation help.

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

Please review our Guidelines here before applying.
LOCATION
Where do you live?

Within the 80540 zip code (Lyons, Allenspark, Raymond, Riverside, etc.)Pinewood Springs/HygieneUnincorporated Boulder County (Stone Canyon, etc.)None of the above/outside Lyons and surrounding areas
Which of the following applies to you?

I work in LyonsI have a child who attends school in LyonsNeither of the above apply to me
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 copy of your driver's license*

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?*

Less than 90 days3-6 months6 months or longer
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?*

Basic Information