Apply for Financial Assistance North Region

Instructions:

If you are a resident of DeKalb, Noble, LaGrange or Stueben county only and in need of assistance, please fill out each section of this form. These questions will help determine if your family may qualify for our Resource and Referral program. 

We cannot process your request without all of this important information, so please answer every question included on the application form.  If appointments are available, a case manager will contact you to schedule an in-person meeting to further determine if we are able to assist you.   

If you need assistance in a different county, please visit our East Region or West Region form.

Please note: we may not be able to respond to all applications due to the extraordinary volume of requests. We genuinely empathize with your financial concerns. If we cannot help you, please see the other resources available to you below.

Additional Resources:

If you or a family member needs additional resources, please call 211 or download a copy of area resources. 

Assistance Form:

Address
Is this address your primary residence?
What type of assistance are your requesting
i.e. clothing, hygiene items, diapers, etc.
Have you received assistance from other organizations toward this bill?
Is the bill/invoice in your name?
Can you provide documentation of the bill/ invoice, lease (if applicable), proof of income?
Are you currently employed?
If you have been directly impacted by COVID19, can you document being furloughed, losing hours or loss of job?