top of page

The Help Squad Assistance Program Client Request Form
The program is based on funding availability
 

Do you live in one of these 4 Areas? Check the box ****Call 211 for Assistance outside of these areas
Colerain Township
Green Township
Delhi Township
Cheviot
Current Need (Check all that apply)
Do you need Rent or Mortgage assistance? Check below
No, Not Applicable
Rent
Mortgage
Are you currently Homeless?
No
Yes
If you are Homeless, please register with the Shelter Network Call 513-381-7233)
No
Yes
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 currently employed?
No
Yes
Lost Job in last 30 days
On Disability
Retired
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
“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

bottom of page