Emergency Assistance Application

Emergency Assistance Eligibility

Do you live in Fulton County or the City of Atlanta?

YesNo

Do you have at least one child registered and attending an APS (Atlanta Public School)?

YesNo

Do you have a lease or mortgage statement in your name?

YesNo

Have you lived and paid three full months of rent or mortgage from your move-in date?

YesNo

Do you have proof of your emergency?

YesNo

Have you worked in the last 12 months?

YesNo

Do you have proof of income (pay stubs, 1099, bank statement, receive Social Security or Disability?

YesNo

Do you have money to use towards what is owed?

YesNo

Have you received financial assistance for rent, mortgage, or utilities from BCM Georgia more than once in the past two years?

YesNo

Have you participated in BCM Georgia’s financial education Program (Budget for Life or 70/30 Project?

YesNo

Have you participated in BCM Georgia’s housing program (Transitional housing or Foundation 3)?

YesNo

Ineligible

You are currently ineligible for Emergency Assistance

Emergency Assistance Application

Please gather all required supporting documents before starting your online application for emergency assistance. Because multiple applicants may be competing for the same available slot, the first person to fully complete the application, upload all required documents, and click “Submit” will secure the slot for review.

Once submitted, a case manager will review your information and determine if you are eligible for an appointment. Applying does not guarantee an appointment or financial assistance.

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Additional Household Members: Children

In the next section please select the Add Additional Household Members to add all the household members.

First name

Middle Name

Last Name

Date of Birth

SS#

Please input as XXX-XX-XXXX

Gender

Relationship to Primary

Education

Race

Ethnicity

Are you Disabled

Name of Atlanta Public School your child attends

In this section please select the "Add Additional Child Household Member" Link below to add all the household members.

Household Income

Income Type

Monthly Amount

$

Income or Expense

Household Expenses

Expense Type

Monthly Amount

$

Income or Expense

Client Support

What do you need help with?

RentMortgage Utilities

How much do you owe?

$

How much will you pay towards your balance?

$

Do you have a late notice or a disconnection notice?

Do you have a lease in your name?

What was your move in date?

Have you worked in the last 12 months, or do you receive disability, social security, or retirement?

In a few words, what is your emergency?

The total file size of the files you can attach to your form can not exceed 30MB. If the attachments you add to this form exceed this amount you will receive a pop-up error message and the submission button will be disabled.

If your files are too large add smaller attachments and note this error in the "In a few words, what is your emergency?" field above.

File Upload

Current Proof of Residency	Proof your child attends APS
Current Proof of Income	Proof of Emergency
Notice of Eviction	Ledger Upload

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