You must live in one of the following zip codes to request financial assistance:

75001, 75023, 75115, 75116, 75204, 75205, 75209, 75219, 75220, 75225, 75229
75230, 75231, 75234, 75235, 75240, 75243, 75244, 75247, 75248, 75251
75252, 75254, 75287.

You must have sufficient verifiable income.
You must have a valid email.

Rent/Utility Applicant Information - if you fail to fill out any part of this application, it may be closed without review.

Name(Required)

Street Address(Required)

Apt #

City(Required)

Zip Code - If your zip code is not listed we do not service your area. Call 211 for information on organization in your area.(Required)

Telephone Number where you can be called(Required)

Type of phone:(Required)

Social Security #

Photo ID#(Required)

Sex (M/F):(Required)

Date of Birth:(Required)

Ethnicity:(Required)

Marital Status:(Required)

Email Address:(Required)

Enter Email Address Again:(Required)

Household Information

Total # of people living in household:(Required)

Where do you live:(Required)

Do you currently receive assistance through DHA/Sec 8:(Required)

Apt/Condo/Motel name:(Required)

Apt Number

Landlord Name:(Required)

Phone:(Required)

One month's rent is? *$(Required)

Move-in Date:(Required)

(date moved on to property)

How many are on Medicaid?(Required)

How many are on SNAP (food stamps, use numbers)(Required)

Monthly Amount from SNAP $

List Information regarding ALL OTHER ADULTS Age 18 or over living in your household: failure to list Adults or children may have your application declined.

DO NOT LIST YOURSELF BELOW - ANYONE ELSE LIVING AT RESIDENCE SHOULD BE LISTED

Adult 1 First and Last Name

Adult 1 Sex M/F

Adult 1 Date of Birth

Adult 1 - Relationship to you

Adult 1 Photo ID #

Adult 1 Social Security #

Adult 2 First and Last Name

Adult 2 Sex M/F

Adult 2 Date of Birth:

Adult 2 - Relationship to you

Adult 2 Photo ID #

Adult 2 Social Security #

Adult 3 First and Last Name

Adult 3 Sex M/F

Adult 3 Date of Birth:

Adult 3 - Relationship to you

Adult 3 Photo ID #

Adult 3 Social Security #

Adult 4 First and Last Name

Adult 4 Sex M/F

Adult 4 Date of Birth:

Adult 4 - Relationship to you

Adult 4 Photo ID #

Adult 4 Social Security #

List Information for ALL CHILDREN under 18 living in your household:

Child 1 First and Last Name

Child 1 Sex M/F

Child 1 Date of Birth:

Child 1 - Relationship to you

Child 1 Social Security #

Child 2 First and Last Name

Child 2 Sex M/F

Child 2 Date of Birth:

Child 2 - Relationship to you

Child 2 Social Security #

Child 3 First and Last Name

Child 3 Sex M/F

Child 3 Date of Birth:

Child 3 - Relationship to you

Child 3 Social Security #

Child 4 First and Last Name

Child 4 Sex M/F

Child 4 Date of Birth:

Child 4 - Relationship to you

Child 4 Social Security #

Child 5 First and Last Name

Child 5 Sex M/F

Child 5 Date of Birth:

Child 5 - Relationship to you

Child 5 Social Security #

Child 6 First and Last Name

Child 6 Sex M/F

Child 6 Date of Birth:

Child 6 - Relationship to you

Child 6 Social Security #

Child 7 First and Last Name

Child 7 Sex M/F

Child 7 Date of Birth:

Child 7 - Relationship to you

Child 7 Social Security #

HOUSEHOLD INCOME INFORMATION

Total HOUSEHOLD Monthly Net Income?*$(Required)

(Auto calculating field)

Source of Your Income?(Required)

Your Monthly Net Income $(Required)

(take home amount)

You must have income to receive NDSM financial assistance

Your Current Employer's Name:(Required)

Phone:

Your Current Employment Length? (example: 6 weeks, 7 months, years) only enter #'s in this box*(Required)

Days, Weeks, Months, Years:*(Required)

Other Monthly Income? $

(take home amount)

Select One

Other Monthly Income? $

(take home amount)

Select One

ADDITIONAL PERSON'S INCOME INFORMATION

Anyone Else in Household Generating Income:(Required)

Source of Additional Person's Income?(Required)

Additional Person's Monthly Net Income $(Required)

(take home amount)

Additional Person's Current Employer's Name:(Required)

Additional Person's Employers Phone:(Required)

Additional Person's Current Employment Length? (example: 6 weeks, 7 months, years)*(Required)

Days, Weeks, Months, Years:*(Required)

Additional Person's Other Monthly Income? $

(take home amount)

Select One

Additional Person's Other Monthly Income? $

(take home amount)

Select One

FINANCIAL ASSISTANCE NEEDED

What kind of help do you need?(Required)

Amount you owe*$(Required)

Brief explanation of why you need this help? (Reason that caused you to be behind)(Required)

A RESPONSE WILL BE EMAILED TO YOU WITHIN 24 HOURS ONCE YOU SUBMIT.

PLEASE READ SCREEN AFTER YOU CLICK SUBMIT FOR IMPORTANT DIRECTIONS.

Proof of Current Income - YOU MUST HAVE VERIFIABLE CURRENT INCOME.

Last Paystub Received from Current Employer

Accepted file types: jpg, gif, png, pdf, doc, Max. file size: 100 MB.

Second to Last Paystub Received from Current Employer

Accepted file types: jpg, gif, png, pdf, doc, Max. file size: 100 MB.

Other Type of Income

Accepted file types: jpg, gif, png, pdf, doc, Max. file size: 100 MB.

Utility Bill

Accepted file types: jpg, gif, png, pdf, doc, Max. file size: 100 MB.

You must have income to receive NDSM financial assistance

By submitting your mobile number, you agree to receive text messages from NDSM. You can opt-out anytime. Message and data rates may apply. Updated 8.8.2023.