Application: Rent, Utilities, Food

Assistance Application  

Additional Documents

• Landlord Verification Form
• Employer Statement of Earnings Form
• Self-Employment Income Statement Form
• Incapacity to Work Form
• Job Search Verification Form

Required Verification

The following required verification must be submitted with your application. Some of the documents listed below may not apply to your particular situation. Please call for more information or if you have any questions.

1. Identification
   • Photo ID or driver's license of applicant(s)
   • Social Security number for each member living in the immediate household
2. Bank statements for any checking and savings account
   • Current month showing balance to date and one full month statement prior
   • Written proof of any resources such as Certificate of Deposits, Individual Retirement Accounts, and stocks and bonds and their current value
3. Written proof of household gross income for prior six weeks
   • Including Social Security, child support, alimony, FIP, food stamps, work check stubs (employer statement of earnings form required if check stubs are not available), "odd jobs for cash," require self-employment income statement form
   • If self-employed, we will need last year's tax return and to-date records for the previous six weeks using the self-employment income statement form.
4. If not currently employed, an Incapacity to Work Form is required if you are temporarily disabled, or a Job Search Verification Form is required that you are actively seeking employment. You must also be registered with the nearest staffing agency
5. If applying for utilities: disconnect notice and current utility bill
   • Utility assistance is limited to the current month billed.
   • Jackson County does not pay reconnect fees.
6. If applying for rent: eviction notice or notice of non-payment and Landlord Verification Form (to be completed by the landlord)
   • Rent cannot be paid to relatives
   • Jackson County does not assist with rental deposits, nor first or last month rent