• Form

  • What is your current Zip code?*

  • ELIGIBILITY ALERT: Applicant is outside Snohomish County and is not eligible for Rainy Day Fund assistance. Review eligibility before proceeding.

  • Basic Needs/Safety Threat

  • What will happen if you do not receive assistance? When will it happen? Is there a notice, shutoff, eviction, or other deadline?*
  • Who is affected and how will this situation affect that person/people?*
  • Is your housing or essential service at risk?*
  • Have you tried another program, agency, payment arrangement, family support, or community resource?*

  • Likelihood Assistance Will Resolve the Crisis

  • Will LINC NW assistance prevent the loss or solve the immediate crisis? If LINC pays only part, is there a way to cover the remaining balance?*
  • Have you received financial assistance from LINC before? If yes, is this a new crisis or has there been a significant change in circumstances?*

  • Staff Decision Section

  • Recommendation
  • Should be Empty: