Have you been financially affected by COVID-19?
DO NOT FILL OUT THIS FORM IF YOU HAVE NOT YET SPOKEN WITH AN ARK VOLUNTEER.
Please fill out this form to apply for financial assistance if you have suffered a loss of income due to the economic impact of the Coronavirus. After completing this form, you will be asked to send in documentation verifying your loss of income. YOU MUST CALL THE ARK AFTER YOU HAVE SENT YOUR DOCUMENTATION IN ORDER TO SCHEDULE A VIRTUAL APPOINTMENT FOR ASSISTANCE. ***Funds are limited: If we do not hear from you within 2 weeks of submitting this form, we will assume you no longer need the assistance, and your application will be removed from the queue so we can better assist those in need.
Have you ever been to the Ark before for financial assistance?
Which county do you live in? (The Ark only serves the follow counties: Clarke, Oconee, Madison, and Oglethorpe unless you are Publix employee)
Other (Does Not Qualify)
First and Last Name
Date of Birth
Employer Name and Contact Info (Email or phone)
Reason for financial assistance
My hours have been cut by my employer due to the Coronavirus
I have been let go from my job due to lack of work / Coronavirus
I have tested positive for COVID-19 and am unable to work
My employer and/or my doctor has ordered me to self-quarantine due to COVID-19 exposure
Has your employer filed for unemployment benefits on your behalf?
What bill(s) do you need help with? Please select all that apply. **Selecting a bill does NOT automatically qualify you for assistance. You must meet Ark guidelines and needs will be met according to availability of funds.
March water bill
March power bill
March gas bill
April Rent / Mortgage
April water bill
April power bill
April gas bill
May power bill
May water bill
May gas bill
For bill assistance, please check off below that you will email us the following documentation to:
or FAX 706-353-1153: (Select all that apply to YOUR circumstance)
REQUIRED OF EVERYONE: last 4 paystubs
FOR SHORT HOURS: letter from employer verifying last day worked and why hours have been cut
FOR JOB LAY OFF: separation notice / letter from employer verifying last day worked and why job ended (We CANNOT help if you are fired for cause or quit voluntarily)
TESTED POSITIVE: letter from employer verifying you are unable to work AND doctor's note verifying positive test result
FORCED TO QUARANTINE: letter from employer verifying you have been asked not to come into work AND letter from doctor
FOR HELP WITH RENT: letter from landlord with total current balance due and how long you have been given to come up with that amount
FOR UTILITY ASSISTANCE: copy of most recent bill you need help with - for GA POWER, please provide us your GA Power account number
FOR HELP WITH MORTGAGE: copy of most recent mortage statement
NEWS YOU CAN USE! Please visit the following links to learn what additional resources and strategies are available to you during these tough times! If you know of additional resources, please click Other and add your resource!
Pause bill payments:
If you are a restaurant worker:
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