You must fully complete all FIVE forms in the box below.
- Proof of income for anyone over the age of 18 in the household via either: One month of pay stubs
SSI or SSDI award letter
Any child support received - Copies of the PAST DUE bills that you are in need of assistance with.
- For assistance with rent, we will need a copy of your lease and a statement of the amount that is past due or eviction.
- For assistance with your mortgage, we will need a copy of your mortgage statement and the amount past due. *The amount must be TWO months past due to qualify.
- If you are looking for a gas voucher must be needed for employment purposes ONLY.
- If you need vehicle repair must have an estimate from an auto repair shop and have proof of ownership with mileage.
If you are interested in receiving assistance, please complete follow the below steps and email your information to stephanie.monskey@indianheadcaa.org
PLEASE NOTE: Must be able to make future payments if assistance is granted.
You can only apply once every 12 months. Be advised there is a financial limit per household.
Finally, funds are provided based on eligibility and type of need.
Assistance is awarded to eligible households who provide all documentation needed on a first come first serve basis as funding is available.
This Emergency Services Program is fully funded by a grant award totaling $96,488.95 (100%) from the US Department of Health and Human Services.