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West Elmwood Housing COVID-19 Relief Fund Application
West Elmwood Housing Development Corporation has established the COVID-19 Relief Fund with the purpose of supporting families who may be experiencing life challenges due to the national pandemic. West Elmwood Housing has limited funding available to assist families on a first-come consideration basis as funds are available.

Based on your answers, a member of the West Elmwood team may reach out to you with additional supports.

Stay healthy and safe!
Email address *
What is your full name? *
Your answer
Home Address (Street, City, State, Zip Code) *
Your answer
Phone Number *
Your answer
How many people live in your household? Please list their relationship to you and ages. *
Your answer
As of March 1, 2020, what was your employment status? *
Has COVID-19 impacted your employment since March 1, 2020? *
Since March 1, 2020, have you seen a decrease in paid income from work? *
What was your total household income in 2019? Please select: *
Due to COVID-19, have you or anyone in your household had to apply to Unemployment?
Do you currently have health insurance? *
Is social distancing and isolation (or other COVID-19 related restrictions) having a negative effect on the mental health of any of the following? (check all that apply)
If you answered checked any of the above, please share how:
Your answer
What type of relief are you applying for? *
How much are you requesting? *
Your answer
How specifically will you utilize the funds? *
Your answer
A copy of your responses will be emailed to the address you provided.
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