Emergency Living Expenses
Apply online (must complete all)
- Patient financial profile (dated within 6 months of request)
- Utility or Rent Assistance Consent Form
- Current rental agreement or utility bill – upload file
- Eviction notice or shut-off warning – upload file
- A letter from the patient/social worker detailing how the patient got into the financial crisis, other agencies contacted for assistance & their decisions, and the patient’s plan to avoid the need for future rent/utility assistance. - upload file
- A letter from the landlord on letterhead that documents: - upload file
1) The patient is the tenant
2) How much money is due and what is covered
3) What time period the money will cover (this needs to be specific, i.e. ‘from 9/10/18 thru 10/9/18’, not ‘one month’), and when the request is approved
4) To whom to make the check payable
5) Where to mail payment
- When a rental agreement or bill is not in the patient’s name and therefore involves someone other than the patient, an written explanation is required of who bears responsibility for payment - upload file
For paper applications:
Download form PDFs