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APPOINTMENT REQUEST
To receive assistance, you must have an interview with a caseworker by
appointment only. If you are interested in scheduling an appointment, please fill out the information below.
The applicant must live in
Forsyth County
. If the primary residence is not within Forsyth County, please call the
United Way at 211 (toll free)
for an agency that serves your area.
*
Indicates required field
Name
*
First
Last
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Phone Number
*
Email
*
Birthday
*
Emergency Causing Need of Assistance
*
Unemployed
Underemployed
Medical
Unexpected Expense
Other
Type of Assistance Needed
*
Rent
Utilities
Other
If Other, please specify
*
If for utilities, what is the amount past due?
*
In Whose Name are Your Bills?
*
Your Name
Spouse's Name
Other
If Other, please specify
*
If for rent, what is the amount owed per "Threat of Eviction letter"?
*
Whose name is on the lease?
*
Household Income Information
Are you employed?
*
Yes
No
Number of adults in the household?
*
Number of adults in the household?
*
Number of minor children in the household?
*
Please list names, ages and schools of minor children in the household (if there are none, please put N/A)
*
Total number of family members in the household?
*
Other sources of income?
*
Child Support
Pension
Social Security
Supplemental Security Income
Social Security Disability Income
TANF
Unemployment Benefits
Food Stamps
Medicaid
WIC
Section 8
Rental/Subletting House
Other
None
*If an appointment is granted, The Place of Forsyth requires a minimum two (2) hour notice, if you must cancel your scheduled appointment.
*Failure to bring required documentation may result in your appointment being cancelled.
Please check
*
I accept the above terms and conditions
Submit
Home
Programs
Thrift Store
Food Program
Senior Outreach
Workforce Development
Emergency Financial Assistance
Youth Outreach
Get Involved
Volunteer
>
Volunteer Opportunities
Volunteer Portal
Donate
>
Make A Donation
Legacy Bricks
The Place Bracelets
About Us
Contact Us
Calendar
Newsletter
Support Us