Faith in Action Chelsea and Dexter MI Covid-19 Emergency Assistance Form
You do not have to complete this form if you are already in contact with our social workers or staff.

We might be able to help you if:
Your household monthly finances fall within about 200% of the Federal Poverty Level over at least the past month (can look here https://www.payingforseniorcare.com/federal-poverty-level#48-Contiguous-States-and-D.C.) - If you are close, please ask!
AND
B. You are in the Chelsea or Dexter School districts
OR
C. You need food assistance and live in the Scio Farms neighborhood or Grass Lake area
OR
D. You need emergency one-time food assistance from our food pantry and live anywhere! (We can also help you find a nearby pantry for future use.)

If you do not meet any of the above criteria you should call 211 for emergency assistance. We likely cannot help you.
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Email *
Which School District is your household is located in? *
First and Last Name of person completing this form *
How many total people, including you, are in your household? *
Please list name and age of all household members.
Phone number: *
Best time to reach you by phone:
Street Address
City
Zip Code
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