General Assistance Application
This is an application for emergency assistance for rent and/or utility bills.
- Drivers License or Photo ID needed! Please bring with you when you return this application.
- Please complete the application in full. Please answer all the questions. Any questions not answered or information not provided will cause your application to be considered incomplete and it will be denied.
- If you have any bank accounts, you will need to complete the Bank release. List the name and location of your bank, all account numbers, date, and sign the release. Do not fill in the account balances. We will send the release to your bank for that information.
- All applicants not currently working must be registered with Iowa Workforce Development, unless you furnish a copy of a Doctor’s statement that you are currently unable to work.
- Income verification for the past 30 days of your entire household is required. This includes all individuals who live in your household whether they are relatives or not. Return with this completed application, the paycheck stubs, or a signed and dated statement of wages earned from your employer(s).
- For utility assistance (electric, heat, water) the current month's bill is needed and must be in the name of the applicant.
- When you have completed this application and have all needed verifications available call our office at (319) 462-4457 (between the hours of 9 a.m. and 1 p.m.) to set up an appointment.
- Completed applications can be emailed to Jan Dole, email@example.com.
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105 Broadway Pl. · Anamosa, IA 52205