Financial Assistance Form

IMPORTANT: Due to the volume of applications we receive, processing your request could take up to 7-10 business days. Our business hours are Monday-Thursday from 9am-5pm.

In order for your application to be considered, you must submit copies of your driver’s license, ALL CURRENT BILLS FOR WHICH YOU ARE REQUESTING ASSISTANCE (screenshots cannot be accepted) and, if requesting rent assistance, a signed copy of your current lease agreement. If you pay rent to an individual (landlord), he/she must complete and return a signed W-9 Form.

If any of the bills are in your spouse’s name, he/she will need to apply separately. Email the documents to or fax them to 855.235.3235.