FHS Fee Assistance Request Form
Fitzgerald Housing Services is accepting referrals to assist Housing Stabilization Services clients in Minnesota to pay application fees for housing. 

Please check your email for follow up questions from FHS staff regarding your request. 

Note: We do not assist with administrative fees.

Referrals must be completed by applicant/client.
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Email *
First Name *
Last Name *
Date of Birth *
MM
/
DD
/
YYYY
Gender *
Senior/Disabled?  *
Are you working with a Housing Stabilization Services provider? *
Phone number *
Email *
Current Address *
List mailing address if you are currently homeless. 
City/State/Zip Code *
County *
Household Size *
Adults *
Minors *
Sources of Income *
Select all that apply for entire household.
Required
Monthly Household Income *
Please provide some details about your circumstances. *
Do you qualify for Moving Expenses? *
Moving Expenses through Housing Stabilization Services
Do you need assistance for ID or birth certificates? (check all that apply) *
Required
Are you requesting assistance for a housing application fee? *
What other resources have you contacted for assistance? *
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