Financial Assistance Request

To receive assistance, you must have an interview with a caseworker. Please fill out the information below.

The applicant must live in Forsyth or Dawson County. If the primary residence is not within Forsyth or Dawson County, please call the United Way at 211 (toll free) for an agency that serves your area.

If for rent, what is the amount owed per "Threat of Eviction letter"? *

Household Income Information

Are you employed? *

Yes No

Number of EMPLOYED adults in the household? *

Total number of adults in the household? *

Number of minor children in the household? *

Please list names, birthdates and schools of minor children in the household (if there are none, please put N/A) *

FINANCIAL ASSISTANCE REQUEST

wHere every Person, Dollar, and Hour has a PURPOSE.

FORMS

SOCIAL MEDIA

MISSION

FINANCIAL ASSISTANCE REQUEST

wHere every Person, Dollar, and Hour has a PURPOSE.

​FORMS

​SOCIAL MEDIA

​MISSION

FORMS

SOCIAL MEDIA

MISSION