Application for Financial Assistance (RRWB)

Resilience and Well-Being Fund Application
Welcome to Arlington Thrive's application for financial assistance.

Financial assistance is available to families through our Resilience and Well-Being Fund (Fund). Arlington Thrive may provide up to $2,000 per family in one-time, flexible assistance, with the exact amount to be determined on a case-by-case basis, in the sole discretion of Arlington Thrive. The Fund will remain open and applications will be reviewed on a rolling basis, to the extent that the Fund has adequate resources. Applications are reviewed according to the requirements listed below.

As part of the application review process, Arlington Thrive staff may request documents such as a lease agreement, bank statements, rental ledger, utility or medical bills, ID/Passport, or other documents needed to determine eligibility for Fund assistance. If you do not have the documents listed above, you may submit alternative documents to verify your need. For more information about acceptable documents, please see the information available here.

Eligibility Requirements for Fund assistannce:
- All family members must have an Arlington County address;
- Family must have a household annual median income (AMI) of 50% or less (see image below); and
- Family must currently be facing challenges due to the loss of a primary wage earner or the loss of primary wage earner income.
If you have any questions about this application or would like to schedule a time to fill out the application in person with a staff member, please email us at assistance@arlingtonthrive.org.

Who is submitting this application?

Organization
Staff Name
Email

Please upload proof of your Arlington County address and a form of identification.
- If you do not have a lease or traditional rental agreement, you may submit a Self-Statement of Residency form (see below)
  - Self-Statement of Residency ENGLISH
  - Self-Statement of Residency SPANISH
- Acceptable forms of identification include a driver's license, state-issued identification card, passport, current school registration documents, postmarked mail, bank statement, vehicle registration, recent utility bill or other official identification records.
ID

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Proof of Address

Please upload a document showing your Arlington County address.
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Now it's time to upload your documents.
- Please upload the most recent versions of all documents.
- If you do not have the documents on the list, please click here.
If you have any questions, please email assistance@arlingtonthrive.org

Rent

Please upload any outstanding rental bills.
For example:
- lease agreement
- rental ledger
- payment records
- correspondence from your landlord
If you do not have a lease or rental ledger, you may upload a Self-Statement of Residency form. See here.

If you have received a pay or quit notice, notice to vacate, or eviction notice from your landlord, please upload a copy of that as well.
Amount requested
Bill or Documentation

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Utilities

Please upload any outstanding utility bills.
For example:
- utility bills
- account statements
- payment records
If you have received a past-due notice, shutoff notice, or disconnection notice, please upload a copy of that as well.
Amount requested
Bill or Documentation

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Food

The total amount given is determined by household size.
What is your household size?
Amount
Medical

Please upload all outstanding medical bills.
For example:
- medical invoices
- billing statements
- payment records
- estimates
Amount requested
Bill or Documentation

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Storage

Please upload all storage bills.
For example:
- invoices
- billing statements
- payment records
Amount requested
Bill or Documentation

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Childcare

Please upload documents of your childcare expenses. Eligible childcare expenses may include fees for a childcare center, daycare program, preschool, before-or after-school care, or other childcare services. Informal childcare provided by relatives, grandparents, friends, or other caregivers may also be considered an eligible expense.
For example:
- invoices
- receipts
- payment records
- provider agreements
Amount requested
Bill or Documentation

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Transportation

Please upload documents of your transportation expenses.
For example:
- vehicle registration
- auto insurance statements
- car payment statements
- fuel receipts
- public transportation passes
- ride-share receipts
- vehicle repair bills
Amount requested
Bill or documentation

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Essential Documents

Essential documents are vital records needed to establish or verify your identity and access important services. Please upload documents of expenses related to obtaining essential documents.
For example:
- invoices
- receipts
- application fees
- or other records related to obtaining or replacing documents such as a birth certificate, state-issued ID, driver's license, passport, Social Security card, immigration documents, or other essential records
Amount requested
Bill or Documentation

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Other

Please upload documents of any other expenses not included elsewhere in this application.
For example:
- invoices
- billing statements
- payment records
- estimates
- service agreements
Amount requested
Bill or Documentation

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Total amount requested

Now it's time to select a payment method.

If your application is approved, you will have the option to receive payment in the form of a check or a pre-loaded debit card.
Please select your preferred payment method.

Now it's time to submit your application.

Please review your application before submitting.
Signature
Should be Empty:

Rows	Full name	Date of birth or age	Gender	Disabled	Veteran	Race	Ethnicity
Partner or spouse
Child 1
Child 2
Child 3
Child 4
Other adult
Other adult
Other adult

Resilience and Well-Being Fund Application

Tell us about your fund request

Please upload proof of your Arlington County address and a form of identification.

Now it's time to upload your documents.

Rent

Utilities

Food

Medical

Storage

Childcare

Transportation

Essential Documents

Other

Now it's time to select a payment method.

Now tell us about your household

Now it's time to submit your application.