Client Application
Application for Emergency Financial Assistance
****Arlington Residents Only****
Please Fill in this form COMPLETELY.

When completing the Assistance Application through the Portal, please be sure to use Google Chrome Mozilla Firefox or Microsoft Edge  . Using these browsers will ensure a successful application submission as Microsoft no longer provides security updates or technical support for older versions on Internet Explorer. Without security updates, user systems become vulnerable to malware. 


Personal Information

Enter your name as shown on I.D.

Employment History

Household Income

Please list ALL sources of Income. Please note you will be required to provide additional information for other household members.
(Amount Housing pays: rent + utility allowance)

Monthly Expenses

Household Information

What bill do you require assistance paying?

Crisis Information