COVID-19 Joint Response Effort for Santa Barbara County

Application for Individual Assistance

Applications are received on a rolling basis and processed in a timely manner.

In order to be eligible for funding, you must submit a completed application for individual assistance.

If you need assistance filling out your application or have questions, please call during the following office hours; Monday, Wednesday and Friday between 9:00am and 2:00pm. Our staff is working virtually. We will return all calls and emails within 24 hours (Monday - Friday). For assistance, please call (805) 965-8591 or email us at info@unitedwaysb.org.

Upon submission, your application will be sent to Family Service Agency, United Way of Santa Barbara County’s contracted partner agency for case management services. A representative from Family Service Agency will contact you to set up an appointment to review your application. Please do not contact Family Service Agency; they will contact you.

You must bring the required documentation to this meeting in order for your application to be reviewed. Acceptable documentation is as follows:

Proof of primary residency from February 2020 to present. You are required to bring Photo ID (Driver’s license, US or foreign passport, or CA ID card) and one of the following other documents: Tax Return, Voter Registration, utility bill, or bank statement.
For applicants under the “loss of job or work"class, proof of employment documents at time of initial business closures (beginning March 2020) that show proof of loss of job or work due to COVID-19. You are required to bring one of the following documents: 2 pay stubs and letter from employer confirming closure at time of disaster. Self-employed individuals should be prepared to provide bank statements or financial statements.
For applicants applying under the "childcare/education class," you will be asked to provide documentation/invoice showing enrollment in a childcare facility.

During your meeting, you and your Family Service Agency representative will review your application and required documentation, as well as discuss your needs. It is your responsibility to honor your appointment time. Your application will not be considered complete until you meet with your assigned Family Service Agency representative. Due to the high number of applications received, FSA will contact you as time allows.

Upon completion of your application and your meeting with Family Service Agency, United Way of Santa Barbara County will review your full application and funding recommendation from FSA and provide written notice of a funding decision. Please make sure to include a viable mailing address for your check to be sent. Please alert United Way of Santa Barbara County if you prefer to pick up your check in person.

For the Individual Assistance Distribution, the following classes of individuals are eligible to apply for funding:

Basic Needs for individuals/families experiencing hardship securing or maintaining basic needs (e.g. food insecurity, need for medical care/equipment, medications, access to mental health services etc.).
Santa Barbara County individuals/families experiencing loss of wages or employment due to business closures, social distancing ordinances etc.
Individuals/families who have experienced hardship due to unexpected childcare/education needs and expenses.

UWSBC retains the right to adjust final funding decisions based upon the number of

Question Title

* 1. Current Contact Information

Name

Address

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 2. At your application review meeting, you will need to bring documentation to demonstrate proof of primary residency in Santa Barbara County during March 2020 to present timeframe. You are required to bring Photo ID (Driver’s license, US or foreign passport, or CA ID card) and one of the following documents: Tax Return, Voter Registration, utility bill, or bank statement.

Do you have this documentation? If not, you may still submit an application.

Yes

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* 3. For applicants under the “loss of job or work" class, at your application review meeting, you must be a Santa Barbara County resident and ALSO provide documents demonstrating proof of employment in Santa Barbara County at time of coronavirus related business closures, social distancing ordinances etc. (March 2020) and that show loss of job or work. You are required to bring one of the following documents: 2 pay stubs or letter from employer confirming closure at time of disaster.

Do you have this documentation? If not, you may still submit an application.

Yes

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* 4. Current Housing Information:

Homeowner

Rent

Shelter

Homeless

Temporarily living with friend/relative

Other (please specify)

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* 5. Up to date with rent or mortgage?

Yes

N/A

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* 6. Rent/Mortgage & Utility Information

Last paid rent date:

Rent amount:

Rent due date:

Average monthly utlities amount:

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* 7. Which class of funding are you applying for?

Individuals/families experiencing basic need insecurities (e.g. food, medical equipment/prescription, access to mental health care, transportation).

Individuals/families experiencing lost wages or work due to coronavirus business closures and social distancing ordinances.

Individuals/families experiencing hardship due to unexpected expenses related to childcare or education supplies/services.

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* 8. Amount of funding requested

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* 9. Describe your loss and need.

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* 10. Please enter funding received from unemployment benefits, insurance, social security, disability, public assistance (calworks, calfresh etc.) and grants from other funding organizations (i.e., 805UndocuFund, GoFundMe, etc.).

Insurance payments

Unemployment

Social Security (please list amount)

Disability (please list amount)

Public Assistance (please list source and amount)

Other funding organization (please list source and amount)

TOTAL AMOUNT RECEIVED:

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* 11. Please provide expenses related to childcare and education needs related to school closures.

Child care costs

Education costs

Total

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* 12. Please enter yourself and each member of your household.

Household member 1 (enter Head of Household here)

Date of Birth

Household member 2 (Name)

Relation to head of household

Date of Birth

Household member 3 (Name)

Relation to head of household

Date of Birth

Household member 4 (Name)

Relation to head of household

Date of Birth

Household member 5 (Name)

Relation to head of household

Date of Birth

Household member 6 (Name)

Relation to head of household

Date of Birth

Household member 7 (Name)

Relation to head of household

Date of Birth

Household member 8 (Name)

Relation to head of household

Date of Birth

TOTAL NUMBER OF HOUSEHOLD MEMBERS (INCLUDING YOURSELF)

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* 13. Address since March 2020

Street Address

City

State/Zip code

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* 14. Employer Information for Individuals Applying for Lost Job or Work (write N/A if not applicable)

Supervisor Name *

Company *

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Email Address *

Phone Number *

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* 15. Total Annual Household Income *Please note: your answer to this question will not affect your eligibility or funding decision. It is requested to track demographics.

Less than $25,000

$25,000 to $34,999

$35,000 to $49,999

$50,000 to $74,999

$75,000 to $99,999

$100,000 to $149,999

$150,000 to $199,999

$200,000 or more

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* 16. Should additional outreach or an in person meeting prove necessary, I live closest to one of the following locations:

Carpinteria

Santa Barbara

Goleta

Lompoc

Solvang

Santa Maria

Guadalupe

New Cuyama

By submitting this application, I agree to the following:

Personal identifying information will be collected and used to determine funding eligibility and amount.
Collected information will be shared between Family Service Agency, the designated case management agency for the United Way of Santa Barbara County Coronavirus Response Fund, and United Way of Santa Barbara County.
Family Service Agency will contact me to set an appointment to review this application and all required supporting documents.

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