Everett Matters Covid Aid Application
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Please fill out the following form. Incomplete applications will not be processed.
Name
*
First
Last
Address
*
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
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Montana
Nebraska
Nevada
New Hampshire
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New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Do you receive mail at this address?
*
Yes
No
Contact Phone Number
*
Email
Number of family members at this address
*
Number above 18 years old
*
Number under 18 years old
Next
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)
Next
Please fill out the following form. Incomplete applications will not be processed.
Are you currently disabled?
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Yes
No
Are you a Veteran?
*
Yes
No
Is anyone in your family working?
*
Yes
No
Is anyone in your family collecting unemployment?
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Yes
No
Next
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?
English
Spanish
Other
Please specify language
How has your ability to meet daily living expenses been negatively effected by Covid-19?
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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
Submit