AUMI COVID-19 Financial Aid Request Form

...serving the least of these.

AUMI COVID-19 Financial Aid Request Form

Your request for assistance will be given serious consideration. Listed below are the steps to be followed: (Applicant must provide proof that the request is COVID-19 related, and MUST be a Fulton County Resident) 1. Complete the request form and provide supporting documentation i.e.

(Must provide a copy of Georgia License or State ID, Copy of late notice from mortgage company/lease/rental agreement, or disconnect notice of utilities) 2. Drop off your completed form between 10am-1pm, Monday-Friday at: 466 Northside Drive, Atlanta, GA 30318 or email to: aumicovid19@ 3. The completed form will be reviewed by our AUMI Financial Team. 4. Upon completion of the initial meeting we may need to speak with you or your mortgage company, property manager or utility company to verify proof of need. 5. We will as soon as possible from the initial request inform you of the status of your request and may refer you to other agencies for further assistance Please be sure that you provide as much information as possible on the form provided.

466 Northside Drive, NW ? Atlanta, GA 30318 ? ? Phone: 404-524-9775 ? Fax: 404-527-5794

...serving the least of these.

AUMI COVID-19 Financial Aid Request Form

Date Name Address City County

How have you been affected by COVID-19?:

Email

Phone

State

Zip

What type of assistance are you requesting?:

Mortgage

Rent

Utilities

Person Contacted:

Telephone #

Do we have your permission to speak with your mortgage company, property manager, or utilities

company with you? Yes

No

Amount of financial assistance requested: $ Your Signature:

Committee's Recommendation:

OFFICE USE

The amount provided: Authorized signature:

Date:

466 Northside Drive, NW ? Atlanta, GA 30318 ? ? Phone: 404-524-9775 ? Fax: 404-527-5794

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