Integrated Family Community Services

IFCS Financial Assistance Application

IFCS Eastern Plains Assistance Application

Financial assistance is available to eligible households in Bennet, Byers, Deer Trail, Strausburg and Watkins. Eligibility for assistance is based on specific program guidelines including income within 125% of the Federal Poverty Level (FPL). Complete the following application to determine eligibility

County of Residence *

City of Residence *

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

Household Members *

Household Gross Monthly Income *

Applicant Information

First and Last Name *

Address *

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

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

Yes

IFCS

IFCS Eastern Plains Assistance Application

Applicant Information

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