United Way of South Sarasota County's Hurricane Ian Emergency Assistance Form
United Way of South Sarasota County is deploying financial resources to our community for those in need of support for housing, rental assistance, utilities and other critical needs. South County residents can request assistance by filling out this form. 

Program Summary and Purpose: 

The Emergency Fund (hereinafter "Fund") is a "last resort fund" established to assist working persons and their families who live in your coverage area- Venice, North Port, Englewood, Osprey, Nokomis or Laurel, who have experienced an unbudgeted and unexpected expense, a lay-off, an unexpected loss of income, or a financial hardship due to a catastrophic event or declared disaster.

The Fund is not a supplemental health insurance and shall not be used to pay any medical expenses.

Each client request shall be considered on a case-by-case basis. 

 

Utilization of Emergency Assistance Funds: 

Employed persons including individuals who have historically been employed but recently lost their job, or who are on a "fixed income" such as social security recipients. Have you recently lost your job or a fixed income? (Please answer question in the upcoming fillable form when asked)


Allowable/ Non-Allowable Expenditures:

Eligible expenditures or emergency funds shall be for basic needs such as rent or mortgage, utilities and other expenses as deemed necessary and approved by Emergency Fund administrator. 

Non-allowable expenses include medical and prescription costs; funeral expenses or travel related to a funeral; expenses for items of an option nature, i.e.: vacations, birthdays, holiday gifts, cable or satellite TV. 

Note: While medical expenses are generally not allowed, a one-time payment for a needed prescription when an employed person meets the other emergency fund guidelines may be allowed. 


Client Assistance Information: Please read carefully and provide the information as requested.

1. Prior to approval of emergency funds assistance, the client must be able to demonstrate that this payment will solve his or her existing problem and not just postpone it. 

If assistance is provided does the applicant have a plan for paying future expenses? (Please answer this question in the upcoming fillable form when asked.)

2. When requesting emergency funds assistance, the client must have documented proof of the unexpected loss of income or unbudgeted expense for an unexpected necessity that has occurred within the ninety (90) days prior to the date of contact. 

3. The amount of assistance should not be greater than the loss of income or unbudgeted necessary expense. However, consideration will be given to the extra costs incurred by the client because of the original loss of income or unbudgeted expense. 

4. Client will pay a portion of the bill if the total bill is more than the loss of income or unexpected expense. 

5. The client's income shall not be a consideration for assistance but may be considered when determining if the client would benefit from a referral to Budget Management Classes.


Emergency Fund Information: 

1. Emergency funds requested are initiated by the completion of an application. 

2. The case manager will review the client's application. All supporting documents regarding the reason for the request and proof of the need (i.e. medical records documenting an illness, bill for car repair, emergency home repair, layoff documents, electric bill, eviction notice, foreclosure notice, etc.) must be provided.

3. Appropriation documentation will need to be obtained from every landlord in rental assistance cases. 

 

If you have any questions, please call the United Way of South Sarasota County Office at 941-484-4811 ext. 101 or email our Office Administrator, Gwen Schafer at gschafer@uwssc.org.

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Contact Information
First Name *
Last Name *
Address *
City, Zip Code *
Email Address *
Mobile Phone Number  *
Are you a South Sarasota County Resident? (Venice, North Port, Englewood, Osprey, Nokomis, and Laurel)  *
Untitled Title
How were you referred? *
Have you ever received assistance from UWSSC before? (If so, please explain when and how much)  *
What kind of assistance is needed?  *
Reason for Request? *
What dollar amount of financial support are you requesting?  *
What is you monthly rent *
What is your monthly utilities cost? *
What is your monthly child care cost?  *
What is your monthly transportation cost? *
Other expenses
What is your monthly take home pay? *
As we do not write checks to individuals, please provide information below for payment. (Payee Name, Address, Contact Name, Account Number, and any other information needed to process payments) *
Are you employed? *
Have you recently lost your job or fixed income?  *
Criteria and definitions for assistance: Which of the below pertain to you? (Choose 1, 2 or 3)  *
If assistance is provided, does the applicant have a plan for paying future expenses? *
Please give a brief explanation for the question above *
Have you contacted 211 for assistance? *
Please provide the name of the agencies you were referred to by 211 along with the date you made contact, the contact name, and the result.  *
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