Please complete this form as completely as you can and staff will reach out to you within 2 business days to schedule a phone screening or provide you with follow up information.
 
9.14.21 Update: Flagler Cares has expended our available eviction prevention funding and we are no longer accepting applications for this program. You may apply for assistance through Florida’s Emergency Rental Assistance Program, Our Florida, here or by calling 833.493.0594.
 
 

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* Applicant/Main Contact

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* What do you want help with?

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* FINANCES. How often does this describe you? I don’t have enough money to pay my bills:

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* WORK. What is  your current work situation?

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* HOUSING. What is your housing situation today?

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* HOUSING. Think about the place you live. Do you have problems with any of the following? (check all that apply)

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* FOOD.  Within the past 12 months, you worried that your food would run out before you got money (or other benefits) to buy more.

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* UTILITIES. In the past 12 months has the electric, gas, oil, or water company threatened to shut off services in your home?

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* MENTAL HEALTH/SUBSTANCE USE. Over the past month, have you experienced any of these (check all that apply):

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* DISABILITIES. Because of a physical, mental, or emotional condition, do you:

  Yes No Not Sure
Have serious difficulty concentrating, remembering, or making decisions?
Have difficulty doing errands alone such as visiting a doctor's office or shopping?
Have difficult getting or keeping employment?

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* What other organizations are you currently working with for help, if any? Please list.

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* How did you hear about Flagler Cares?

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* Is there other information you want to share?

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