Integrated Family Community Services

Financial Assistance Application Checklist

Financial Assistance helps families meet their basic needs for well-being and safety and serves as their path to self-sufficiency. IFCS provides temporary financial assistance and supportive services to low-income households.

Eligibility for financial assistance is based on specific program guidelines including citizenship and qualified noncitizen resident status; residency in IFCS’ service area; and monthly income eligibility guidelines.

Am I eligible for financial assistance?

IFCS Financial Assistance Application

I live in the county of (Text Box/Drop Down) and the city of (Text Box/Drop Down).

Only the following COUNTIES will be accepted *

Only the following CITIES will be accepted

My household size is (Text Box/Drop Down) and monthly gross income is (Text Box/Drop Down).

HOUSEHOLD accepted

Only the following INCOME will be accepted

Applicant Information

First and Last Name

Address

City

State/Province

Zip/Postal

Country

Phone

Have you previously received assistance?

Yes

If yes, explain:

What circumstances have led to your need for financial assistance? Please be specific.

Seeking help with paying rent/mortgage?

Amount and Due Date

Seeking rent assistance? Please email IFCS@IFCS.org a signed copy of your current lease. Include all pages. This must be done to receive assistance.

Seeking help with paying electric and/or gas?

Amount and Due Date

Please email IFCS@IFCS.org a copy of your current electric, utility or other bill. Include all pages.

Seeking help with paying another bill?

Amount and Due Date

Household Information

Please list all adult and child members living in the home. Including yourself. Gross income is the amount before taxes, deductions for healthcare, garnishments, etc. Email IFCS@IFCS.org copies of paystubs for the last calendar month.

List of Household Members Including Yourself

Full Name:

Date of Birth

Monthly Gross Income

Add Remove

Total Number of Persons in the Household

Total Monthly Gross Income

Application Checklist - Please Email all Items to IFCS@IFCS.org

Picture ID for all adults (18+ years old) in the home

Identification for all children (0-17 years old) in the home

Proof of income for all adults (18+ years old) in the home

Copy of lease agreement, complete and signed

Copy of electric and/or gas or other bill

Signature - By Clicking Yes, you are certifying your answers are true and complete to the best of your knowledge

Yes

IFCS

Financial Assistance Application Checklist

Applicant Information

Household Information

List of Household Members Including Yourself

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