APPLICATION FOR ASSISTANCE

Date

YYYY

Name

First Name

Last Name

Sex

Male

Female

Address. If homeless, state "homeless"

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Mailing Address

Phone Number

Do you have an illness or disability which prevents you from working? Is the illness or condition permanent? If temporary, when will you be able to return to work? *If you are able to work, Almost Home will assist with helping locate possible employment opportunities - for our able clients, we do require an active job search while receiving assistance *

Have you applied for Link? Approved/denied/date approved or denied? If you are requesting assistance with food: If you are pregnant or have children under age 5 - you must apply for WIC prior to requesting assistance for food through Almost Home Chicago

Are ongoing illnesses/medications covered by insurance?

Medical or Emergency Contact

Sources of Income

List below your sources of income and how often you receive them. Please be specific. Almost Home may request proof of income to complete the application process.

Living Situation

Select one

List your monthly bills. Please be specific. Almost Home may request proof of financial obligations to complete the application process. If you are behind on bills you are requesting assistance for, you must provide a copy of the current month bill showing past due amounts. All bills must be in the applicant's name.

Gas, Electric, Phone, Water, Car payment, Car insurance, etc.

Other Assistance Applied for

If applicable, describe the following assistance, for which you have applied. Examples : Medicare/ Medicaid, Fuel assistance, Social Security Disability, aid from the Town Welfare Office, aid from the Veteran’s Administration

List other assistance applied for. Please provide dates applied and whether approved or denied. You will need to provide documentation of approval/denial. If you are applying for assistance with utilities, you must apply with CEDA first. If CEDA has denied you, we will need to see a copy of the denial letter.

What are you requesting assistance with? Please list specific amounts. If applying for assistance with multiple items, please list them in order of priority.

I/We wish to apply for assistance offered and provided by Almost Home Chicago, Inc. I/We understand that our participation in such a program is voluntary and that these benefits are provided by Almost Home Chicago, Inc.

By choosing "yes" you acknowledging this serves as an electronic signature until a physical one can be obtained

Directions for applying:

A completed application must be submitted before any request for assistance is considered. All applicants requesting assistance with rent, mortgage, and/or utilities must submit below documentation.

Valid driver's license or state ID (Your ID must reflect your residence in one of our service areas).
Copy of current bill for which you are requesting assistance. (Electronic or Paper)
We may request proof of current financials to determine eligibility for services.

Service Area: Alsip, Bridgeview, Burbank, Chicago Ridge, Evergreen Park, Hometown, Mt Greenwood, Oak Lawn, Palos and Worth.

FREQUENTLY ASKED QUESTIONS ABOUT ASSISTANCE

How can I request assistance?

You will find the application to request assistance under the “Application to Request Help” tab on this website. * PLEASE NOTE * You must reside in one of our service areas to receive assistance. All homeless applicants will be considered, regardless of current location. Please contact us via phone or email if you need assistance with completing your application.

Do I need documentation?

Yes. We will request documentation to support your case. We request that documentation be submitted within 72 business hours. Your case manager will talk to you about needed documentation for your request.

I am living in my grandfather’s house and the bill is still in his name. Can I still apply?

All bills must be in the applicant’s name to be considered for assistance.

What kind of assistance do you offer?

Almost Home does not offer assistance with cable or satellite television, graduation fees, sporting fees, income taxes, or tuition. Almost Home reserves the right to make the final decision on any applicant’s request, and all information provided within request will be taken into consideration.

I need a place to live. Can you find me an apartment?

Almost Home does not locate or provide housing. However, if an applicant locates housing in one of the listed service areas, they may apply for assistance with a security deposit as an alternative.

I just need a little cash to get me through the week.

Almost Home does not give cash assistance for any request. Assistance granted will be paid directly to the utility company, landlord etc. Emergency food, gas, and basic needs will be evaluated and provided on a case by case basis.

How much can I get?

Almost Home reserves the right to cap the amount of assistance given to any applicant in a calendar year. Assistance is limited to no more than $1500 in one calendar year.

When will I hear something?

Your application will be reviewed by the Board of Directors and if your need is something we can assist with you will be contacted within 3 business days.

How do I know I am eligible to apply?

In accordance with Federal Law, Almost Home Chicago, Inc. does not discriminate on the basis of race, religion, national origin, sex, gender, mental or physical handicap, marital status, familial status, parental status, sexual orientation, genetic information, political beliefs, reprisal, or because all or part of an individual’s income is derived from any public assistance program.

Although we cannot guarantee approval of any application for assistance, if you are in our service area, all are welcome to apply, and all applications will be reviewed with care and diligence.

Almost Home Chicago, Inc

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