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Our Story Is Foundation

Emergency Relief Application

This application helps us understand your situation and assess short term emergency support. Each submission is reviewed with care in accordance with program guidelines and current capacity.

Estimated time

Under 10 minutes

Privacy

Your information is treated as confidential and used only to assess your request.

Application Intake Header

Our Story Is Foundation

Emergency Relief Application

This application is used to assess short-term emergency support for individuals and households experiencing unexpected hardship. Each submission is reviewed carefully and respectfully by our team in accordance with program guidelines and current capacity.

The form is divided into a few brief sections to help us understand your circumstances clearly and evaluate requests fairly. Most applicants complete the application in under 10 minutes.

Before you begin

Please provide information that is accurate to the best of your knowledge.
Submitting an application does not guarantee assistance.
All information shared is treated as confidential.

Use the “Next” button below to move through each section.

Estimated time: under 10 minutes

Legal First Name *Please enter the name shown on your ID or official documents.

Legal Last Name *Please enter the name shown on your ID or official documents.

Preferred Name (optional)

Date of Birth *

Mobile Phone *We will only contact you regarding your application.

Email AddressOptional, but helpful if available.

Preferred Contact Method *TextPhone CallEmail

Best Time to Reach You *MorningAfternoonEvening

Language Preference *

If Other, please specifyOnly if you selected "Other" above.

ZIP Code *Enter your 5 digit ZIP code.

City (optional)Optional, but helpful.

Housing Status *HousedTemporarily HousedUnhousedAt Risk of Losing Housing Within 30 Days

If unhoused or temporarily housed, where are you currently staying or what area are you inThis helps us coordinate support and delivery if needed.

Primary Type of Support Requested *

How urgent is your request *Within 72 hoursWithin 7 daysWithin 30 days

Briefly describe what happened and what support would stabilize things right now *You do not need to share more than you are comfortable with.

If your request is tied to a specific upcoming date, you may share it here

Current Employment Status *

Approximate Household Monthly Income (Before Taxes) *Please select the range that best reflects your household’s total monthly income. This information helps us understand context and does not automatically determine eligibility.

Recent Financial Changes *Select any changes that have occurred within the past 90 days.Job lossReduced work hours or incomeMedical or health-related expensesUnexpected major expense (e.g., car repair, emergency travel)Housing-related changes (rent increase, move, temporary displacement)Caregiving responsibilitiesBusiness or self-employment disruptionOther significant change not listed aboveNo recent financial changes

If you selected any changes above, briefly explainPlease share only what feels relevant to your current situation.

Current Assistance or Support Programs *Select any programs or support you are currently receiving.SNAP (food assistance)WICSSI or SSDIUnemployment benefitsHousing assistance or rental supportMedical assistance or health coverage supportChildcare or caregiving assistanceSupport from family or friendsOtherNo current assistance

Please specify other assistance or support

Have you received grocery or emergency assistance from another organization in the past 14 days *YesNo

If yes, which organizationThis helps prevent overlap and allows us to coordinate responsibly.

Dietary Needs or AllergiesPlease share any dietary considerations that may affect food selection.0 / 250

How can you receive groceries if approved *PickupDeliveryEither option works

Do you have access to the following *Reliable transportationRefrigeratorFreezerStove or hot plateMicrowaveLimited or no kitchen access

Preferred way to contact you regarding this request *Text messagePhone callEmail

Confirmation of Information Accuracy *Confirmation of Information Accuracy

Use of Information *I understand that the information provided will be used solely for application review, coordination of support, and program administration.

Consent to Contact *I consent to being contacted by Our Story Is Foundation regarding this application.

Acknowledgment of Review Process *I understand that submitting an application does not guarantee assistance and that support is provided based on availability and program guidelines.

Application Review Notice

Thank you for completing this application.

Submissions are reviewed carefully and respectfully by our team. If additional information is needed, we will contact you using your preferred method.

Please note that submitting an application does not guarantee assistance. Support is provided based on urgency, availability, and program guidelines.

Please do not fill in this field.

Emergency Relief Application

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