If you were impacted by COVID-19 and need assistance, please complete the form below:

Note: Please only submit one application. Duplicate applications will not be considered.

Information for landlords and property owners

Important Information for Applicants

Eligibility Requirements:

Eligibility:

We are prioritizing help for individuals and families who have lost income as a direct impact of COVID: through job loss, wage loss, furlough, illness, quarantine, lack of childcare or other related incidents. You must belong to one of these groups:

  • Single-headed households with children
  • Families with 5 or more minor children
  • Immigrants/Refugees
  • Seniors (age 60+)
  • Disabled
Documentation Requirements:

Documentation Required:

  • Copy of your photo ID (driver’s license OR other official picture ID)
  • For rental assistance (any one of these): lease AND vacate/eviction notice, OR rental agreement document
  • For utilities assistance (any one of these): utility disconnect notice OR late payment notice
  • Proof of unemployment (any one of these): copy of Workforce Solutions appointment/application, letter stating you have lost unemployment, pay stub, letter of employment loss for informal workforce, OR declaration of lost income

For additional additional resources and information please visit Catholic Charities Coronavirus Information Page.

1 UPDATED COVID Assistance Form

COVID-19 Assistance Request Form

Gender: *
Marital status: *
Primary language: *
Are you a veteran? *
Race: *
Ethnicity: *
Has someone in your household been diagnosed with a disability? *
Please enter a number. If someone’s monthly income was $600.00, they would enter 600.
Household Income: *
Eligible for COVID unemployment/government stimulus? (NOTE: Your answer to this question will not impact your ability to receive assistance from Catholic Charities. See additional information from IRS.gov and the Texas Workforce Commission.) *
Address *
Address
City
State/Province
Zip/Postal
Country
Housing status: *
Please enter a number. If someone’s typical monthly housing payment was $600.00, they would enter 600.
Note: even if this was not paid in full last month, enter what this payment would usually be.
Were you able to make your monthly housing payment in full last month? *

Financial Impact

How were you impacted by the COVID-19 crisis? *

Assistance Requested

Check all that apply: *

Additional Questions

Your answer to these questions will not affect your access to financial assistance.
Please enter a number. If someone spent $600.00 housing, they would enter 600.
Note: utility costs are covered in the next question.
Please enter a number. If someone spent $600.00 utilities, they would enter 600.
Note: even if these costs are included in your monthly housing payments, enter what you think your expense for utilities was.
Please enter a number. If someone spent $600.00 food, they would enter 600.
Please enter a number. If someone spent $600.00 food, they would enter 600.
Getting enough food can be a problem sometimes. How confident are you that your household will be able to afford the kinds of food you need for the next four weeks? *
(Select only one answer.)

Consent to Participate in Study

Do you consent to partake in this study? By clicking “yes” below you are indicating that you are at least 18 years old, that you understand the procedures described above, and that your questions have been answered to your satisfaction. *
Do you agree to be contacted after your study participation for additional information? *
By checking this box and typing my name below, I am electronically signing this consent form. *

Acknowledgement and Consent for Services

I, the undersigned, hereby authorize the release of information to Catholic Charities of the Archdiocese of Galveston-Houston for the purpose of determining program eligibility and monitoring program compliance. (The disclosures made are limited to the information listed here: Houston Food Bank; United Way.) By selecting "yes, I agree" below, I am acknowledging that I have read and understood Catholic Charities' eligibility forms prior to submitting this application for assistance. (Read and review the consent information: ENGLISH | SPANISH). *