Financial Assistance Request

Assistance Requested

Unfortunately, JFS does not currently offer services to assist you. We encourage you to contact Washington 211 for additional resources. For employment resources, please visit WorkSource.

To receive assistance, you must provide a lease, a ledger from your landlord, and a W9 from your landlord.

All information provided is subject to verification. If found to be inaccurate, financial assistance will not be provided.

Do you have an eviction notice?*

Yes

No

Do you have past due rent?*

Yes

No

How many months rent is past due?*

How much money do you owe?*

All information provided is subject to verification. If found to be inaccurate, financial assistance will not be provided.

Have you identified a specific unit?*

Yes

No

To receive assistance, you must provide a copy of the bill which shows your name, address, account number, and the total owed.

All information provided is subject to verification. If found to be inaccurate, financial assistance will not be provided.

Do you have a shut-off notice?*

Yes

No

All information provided is subject to verification. If found to be inaccurate, financial assistance will not be provided.

What is your current annual household income?*

Are there any children in your household?*

Yes

No

How many people are in your household?*

Number of bedrooms in your home?*

All information provided is subject to verification. If found to be inaccurate, financial assistance will not be provided.

Have you ever received assistance from Jewish Family Service?*

Answering “no” does not negatively impact your eligibility for assistance.

Yes

No

Did anyone refer you to JFS?*

Yes

No

Who referred you to JFS?

Are you Jewish?*

Answering “no” does not negatively impact your eligibility for assistance.

Yes

No

Are you connected to the Jewish community?*

Answering “no” does not negatively impact your eligibility for assistance.

Yes

No

What is your connection to Judaism or the Jewish community?

All information provided is subject to verification. If found to be inaccurate, financial assistance will not be provided.

Please describe your situation.*

Unfortunately, JFS does not currently offer services to assist you. We encourage you to contact Washington 211 for additional resources.

This field should be left blank

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