Everett Matters Covid Aid

Please fill out the following form. Incomplete applications will not be processed.

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Do you receive mail at this address? *

Contact Phone Number *

Number of family members at this address *

Number above 18 years old *

Number under 18 years old

Please fill out the following form. Incomplete applications will not be processed.

Documentation *

Click or drag files to this area to upload. You can upload up to 10 files.

Please provide any documentation verifying loss of income due to COVID19. This includes showing that you are behind on your rent, a printed bank statement and/or 2 paystubs from the last 30 days of unemployment. If you are unable to provide a printed bank statement please upload a signed attestation stating “I, _(printed name)_ am unable to pay my rent due to COVID19 and do not have the ability to provide a bank statement.” – Please include signature and Date.

Documentation *

Click or drag files to this area to upload. You can upload up to 10 files.

Please upload your lease, at least one form of personal identification, verification of current income (2 paystubs from the last 30 days of employment for ALL household members; If unemployed, please provide the unemployed benefit verification from Massachusetts Dep. of Unemployment)

Please fill out the following form. Incomplete applications will not be processed.

Are you currently disabled? *

Are you a Veteran? *

Is anyone in your family working? *

Is anyone in your family collecting unemployment? *

Please fill out the following form. Incomplete applications will not be processed.

Do you receive other food assistance?

SNAP
WIC
P-EBT
I do not receive food assistance

What Language do you wish to be communicated in?

Please specify language

How has your ability to meet daily living expenses been negatively effected by Covid-19? *

Please specify how your ability to meet daily living expenses been negatively affected because of the COVID19 pandemic

What do you need assistance with? *

Food assistance
Rental assistance
Legal Aid (eviction)
Emergency Housing Assistance
Other

Select all that apply

Other Assistance

Everett Matters Covid Aid Application

Please fill out the following form. Incomplete applications will not be processed.

Please fill out the following form. Incomplete applications will not be processed.

Please fill out the following form. Incomplete applications will not be processed.

Please fill out the following form. Incomplete applications will not be processed.