Eagle County Emergency Assistance Request
Please use this form to request assistance from Eagle County due to hardships your household is experiencing due to the impact of COVID-19.

Examples of assistance that may be available include but are not limited to: rental/mortgage assistance, utility assistance, emergency food assistance, household supplies, and transportation assistance. We request that you do not request assistance for any expenses that are being covered by other agencies.

This emergency assistance is not included in the list of federal programs that is considered when determining public charge.

The county is prioritizing applications based on financial need. This fund is separate from any federal or state stimulus package and is needs-based for local residents. If you already have resources available to cover immediate needs and expenses, your application may be denied.

Please leave a working phone number so that we can contact you to conduct a brief interview to collect the information necessary to determine what/which resources may be available to you. We will do our best to contact you as quickly as possible.
What is your full name *
Your answer
What is your date of birth?
What County do you live in *
What is your physical Address *
Your answer
How many people are in your household? *
This refers to how many people are in your home that will be receiving assistance
Your answer
Are there any children under the age of 18 in your household? *
Are you and/or members of your household lawfully present in the United States? *
Please note that if your answer is "No", that does not mean that you will not be eligible for assistance. *
What is your Phone Number? *
Your answer
What is your email address? *
To limit in-person contact, please provide an email address where we can send correspondence or requests for information.
Your answer
What is the CURRENT income for your household? *
If you have been laid-off and are waiting to return to work or for unemployment benefits that you are not currently receiving, you can say your income is $0.00 at this time. *
Your answer
Please indicate how much cash on hand or checking/savings you have available at this time. *
Your answer
What type of assistance do you need at this time? *
Other types of assistance needed?
If you need other assistance not listed above, please describe
Your answer
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