Client Inquiry Form



How many people reside in your household ?
Date of Birth
Do you wish to receive a text alert regarding your request? Message and data rates may apply.
Date of Eviction/Disconnection:


Did your financial crisis occur within 6 months of the date you are seeking assistance?


What documentation can you provide as proof of financial crisis? This will be documentation showing the cause of what has happened out of the ordinary, within the last 6 months, to put you in need of assistance. Rental and utility bills/notices cannot be used.


I understand that this submission does not guarantee that Matthews HELP Center will be able to assist me with my request:

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