Housing assistance request

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Complete this form to request financial assistance for housing. This form should be completed each month, regardless of discussions with the bishop about the length of financial assistance you will receive from the ward.

Complete and submit this form by the second-to-last Sunday of the month before the month for which you are requesting financial assistance. This will help ensure that the ward issues these checks in a timely manner and it will help you avoid late fees and other potential financial penalties imposed by your landlord or lender. Note that the ward generally will not pay late fees when they otherwise could have been avoided.

Requestor

Last name *

First name

Telephone number with area code

Email address

Street address *

City *

State

New York

Other:

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ZIP code

Have you discussed your self-reliance plan with the bishop within the past three months? *

If no, please see the executive secretary to schedule an appointment with the bishop as soon as possible.

Yes

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