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Welcome to The Help Squad Assistance Program Client Request Form

The Help Squad Assistance program is based on funding availability and
this form will no longer be available when we meet our Quota.
 
The new DRIVE Car Repair Program is only available to those in the Help Squad Service areas or
experiencing Homelessness who are enrolled 
in a prevention program with
Strategies to End Homelessness (STEH) Shelter Program. 
*****Due to the Overwhelming response of those in need
please be patient
as it may take several days for a response.
​

All information obtained in this application is kept strictly confidential and used only by our staff for 

assessing eligibility for assistance and for providing assistance to qualified applicants. 

Is your address in Colerain, Cheviot, Delhi or Green Township
Yes (if yes, please continue completing the application)
No (if no, STOP completing the application & call 211 for connection to services)
Are you Currently Homeless?
Yes (if yes, STOP completing the application and contact Strategies to end Homeless 513 - 381 - 7233)
No
Are you in need of emergency financial assistance?
Yes
No
Are you Currently working Full time or have sufficient Income prior to your setback?
No (Stop completing the application and contact 211 or Ohio Job & Family Services)
Yes (please continue with the application)
Lost Job in last 30 days
On Disability
Retired
Do you need Rent or Mortgage assistance? Check below
No, Not Applicable
Rent
Mortgage
Have you received assistance from The Help Squad in the last 12 months?
No
Yes
How many adults live with you?
1
2
3
4+
How many children live with you (under 18 years of age)?
1
2
3
4+
Are you a US Citizen or do you have a green card, work permit, or student visa?
No
Yes
Does any member of your household have a disability or special need?
No
Yes
Were you referred to The Help Squad by another organization or agency?
No
Yes
Are you working Full-time?
No
Yes
Part-time
How many hours do you work?
<10
10-25
25-39
40+
How many other adults living in your household work at least 36-40 hours per week?
0
1
2
Are you a Veteran?
Yes
No
Are you enrolled in pre courses for a GED or at a college or trade school?
Yes
No
CAN A PAYMENT BE MADE BY PHONE CALL?
YES - provide the contact information below
NO
“I never imagined myself in this position with 5 kids and no where to turn. Thank you for being there for me and helping me through this. I have a job, daycare vouchers, food, housing and hope because you cared. I want to come back and help others who are hurting like I was…..”

Mother of a NWLSD family

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