HOME>FINANCIAL STRUGGLES>APPLICATION REQUEST If you are a single parent with school age children, and you would like to request an application to receive financial assistance, please complete the form below. Click here to view our Privacy Policy. After completing the form below, click the "Submit" button at the bottom of the form. Your request for financial assistance will be reviewed and processed right away. If your request is accepted, you will be notified at the email address provided on this form. In addition, you will receive a complete package in the mail with a formal application for financial assistance along with several other forms. These additional forms are necessary to help us properly determine the amount of financial assistance you may qualify for. Our goal is to help all parents with school age children receive the maximum amount of financial assistance for which they qualify, whether it be from the MEO/CF, or some other organization, be they independent organizations or government sponsored programs.

Select One YES NO

Are you at least 18 years old?

Select One Single Mother with 1 child Single Mother with 2 children Single Mother with 3 children Single Mother with 4 children Single Mother with 5 or more children Single Father with 1 child Single Father with 2 children Single Father with 3 children Single Father with 4 children Single Father with 5 or more children

I am applying as a:

Select One Receive Financial Assistance

I am applying to:

My  of monthly income comes from the following source(s):

Select One YES NO

Select One ZERO $1 - $100 $100 - $200 $200 - $300 $300 - $400 $400 - $500 $500 - $600 $600 - $700 $700 - $800 $800 - OR MORE

Section 8

Select One YES NO

Select One ZERO $1 - $200 $200 - $400 $400 - $600 $600 - $800 $800 - $1000 $1000 - $1200 $1200 - $1400 $1400 - $1600 $1600 - OR MORE

Social Security Income

Select One YES NO

Select One ZERO $1 - $100 $100 - $200 $200 - $300 $300 - $400 $400 - $500 $500 - $600 $600 - $700 $700 - $800 $800 - OR MORE

Food Stamp Program

Select One YES NO

Select One ZERO $1 - $100 $100 - $200 $200 - $300 $300 - $400 $400 - $500 $500 - $600 $600 - $700 $700 - $800 $800 - OR MORE

Child Support Payments

Select One YES- Part Time Job YES- Full Time Job NO

Select One ZERO $1 - $200 $200 - $400 $400 - $600 $600 - $800 $800 - $1000 $1000 - $1200 $1200 - $1400 $1400 - $1600 $1600 - OR MORE

Full or Part Time Employment

Unemployment Compensation

Select One YES- Unemployment NO - Unemployment

Select One ZERO $1 - $200 $200 - $400 $400 - $600 $600 - $800 $800 - $1000 $1000 - $1200 $1200 - $1400 $1400 - $1600 $1600 - OR MORE

Select One YES- Other Comp NO - Other Comp

Other Form of Compensation

Enter Amount

All Selections must be made to validate this application!

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