Furniture Assistance Application Form

FURNITURE ASSISTANCE PROGRAM

Referral only in order to receive service.

Please note: In order for our staff to respond to your application in a timely manner, be sure to answer the questions on this application precisely as possible. Remember to upload a legible proof of income and photo identification, so it doesn’t delay the process. Answer all the questions asked. If any question does not apply to you, answer “none,” “not applicable,” or “unknown.” You must provide detailed information and answer the questions as completely as possible.

After reviewing your application, our staff will contact you to schedule an inspection.

Name (First and Last) *
Phone Number *
Email Address *
Age *
Street Address
Address *
Postal Code *
City *
State *
Baltimore City/Country *
Does your household receive any type of public assistance? (SNAP, EBT, Section 8 housing, Disability, Energy Assistance Program, etc.) *
Does your household earn below 200% of the Federal Poverty Guidelines? (Not sure? Please copy and paste the following link into a new window to determine your eligibility: https://aspe.hhs.gov/poverty-guidelines ) *
Can you provide verification of need in some form? (Tax return, SNAP card, caseworker verification, police report, letter from community leader etc.) You will need to present this during your appointment.*
Number of People in Household *
Proof of Income*
Photo ID *
Do you own or rent your home? *
What type of home do you have? *
Name of Caseworker or Counselor *
Phone Number and/or Email Address of Caseworker or Counselor *
Referral Agency or Organization *
How did you hear about the Furniture Assistance program?
Tell us the most important things you need for your home*

Furniture Assistance Application Form

FURNITURE ASSISTANCE PROGRAM

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