Ethaar Financial Assistance Application

Welcome to the Financial Assistance Application. Please provide accurate and complete details to facilitate the evaluation process. Your privacy is important to us, and all information submitted will be handled with confidentiality.

Contact Information

Full Name *

Cell Phone *

Email *

Existing Client

Has your family received services from Ethaar before? *

YesNo, this is my first time

Employment

What is your current employment status? *

UnemployedEmployed full-timeEmployed part-time

If unemployed, have you applied for unemployment benefits through the Georgia Department of Labor? *

YesNoNot applicable (I am employed)

What is your total monthly household income?

Housing

Describe your current living situation *

How much is your monthly rent or mortgage? *

Are you facing eviction or other housing difficulties? *

YesNo

What Do You Need Help With?

Are you requesting a one-time payment or ongoing support? *

One-time paymentOngoing/recurring support

If recurring, for how long?

What do you need help paying for? (select all that apply) *

Other (please specify)

Emergency & Health

Are you facing any urgent financial emergencies right now? If so, please describe and include estimated costs. *

Do you or a family member have any health concerns, injuries, or illnesses? *

Previous Assistance & Assets

Do you receive SNAP benefits (food stamps)? *

YesNo

Do you own any significant assets? (property, vehicles, savings — please include amounts) *

Does your family own a vehicle? *

YesNo

Did you receive a tax refund this year? If so, how much? *

When did you last receive financial help from another organization or individual? *

Have you recently applied for financial help from other organizations? *

Monthly Expenses

Please list your monthly expenses including rent, utilities, phone/internet, and any other regular costs.

List your monthly expenses *

Required Documents

Please upload your bank statements for the last 3 months, recent pay stubs, and a valid form of ID. You can upload multiple files.

Upload your documents*

PDF, JPG, or PNG — max 10MB per file.

Consent & Agreement

The following legal text is provided in English only for accuracy and will not be translated.

Disclaimer The applicant acknowledges that Ethaar may require additional documentation or information to verify the application details. By submitting this application, the applicant consents to such verification and agrees to cooperate fully with any requests for additional information. Ethaar is committed to a fair and transparent evaluation process for all financial aid applications. However, decisions regarding the allocation of financial aid are final and are not subject to appeal. Authorization By filling and submitting this form, I hereby authorize Ethaar, along with its agents and employees, to obtain, share, and discuss my case information with other non-profit organizations, individuals, and resettlement agencies that may assist with my requirements. The types of information that may be shared include, but are not limited to, Entry/Exit Dates, Psychological Evaluations, Case Summaries, History of Abuse, Details on Children including their names, Assessments, Legal Documents, Substance Abuse records, and any other relevant information. I understand and acknowledge that my consent for the above is granted indefinitely. However, I retain the right to withdraw this consent at any point in writing.

I understand and agree to the terms above. *

Client Agreement

The following legal text is provided in English only for accuracy and will not be translated.

• I agree to provide any relevant documentation supporting financial claims. • I certify that the above statements and information are accurate to my knowledge. • I consent to use this information to determine my eligibility for financial assistance. • The application may only be accepted once the information is verified. • Meeting the criteria does not guarantee approval or financial assistance.

I agree to the following conditions. *