Application For Relief

30 October, 2020

Please fill out the below information for initial relief screening. A NewFit Member will reach out to you via email/phone to work with you.

Application for Relief

Name *

First

Last

Date of Birth *

Email *

Address *

Phone *

Military Veteran

Total Members in Household, if Applicable

Income - Do you and/or people that live with you receive income?

Marital Status

Name of Spouse

Employment Status

If Unemployed, are you currently recieving any Unemployment benefits?

Employer (If Married, you may include Spouse Employer)

Income Level (Annual Salary)

Description of Housing Status (Where do you currently live?)

Description of Relief Request

Describe Relief Request (State reason why your are requesting relief)

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