Financial Aid Request

PORTLAND REFUGEE SUPPORT GROUP

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Financial Aid Request

WARNING: If you use your smartphone to submit this form we may not receive it. Please use a computer. Thank you!

* This form is FOR PRSG VOLUNTEER USE ONLY. If you're not with PRSG please CONTACT US.

* Indicates required field

Today's Date (month/day/year) *

Amount Requested *

Is this request related to COVID? *

Yes No

What is this aid for? *

Water Bill Electric Bill Natural Gas Bill Phone Bill Partial Rent Bill Full Rent Bill Other

If Other, please specify in 2 or 3 words (or type N/A) *

Due Date *

Please allow 7-14 days for processing.

Client Information

Client Legal Name *

First

Last

Client Cell Phone *

Client Address *

Line 1

Line 2

City

State

Zip Code

Country

Volunteer Information

Volunteer Name *

First

Last

Email *

Cell Phone *

WHAT HAS CHANGED IN THE CLIENT'S SITUATION TO NEED THIS AID NOW? *

What's the client's self-sufficiency plan? *

Have you, as a volunteer, tried finding other aid resources for the client? *

Yes No

IF NOT, PLEASE CLICK HERE FOR RESOURCES

Any Comments? *

I will email a picture of the bill(s) ASAP to: yasser@pdxrsg.org

Please allow 7-14 days for processing.

∙ Make sure you click the SUBMIT button well, until you see the confirmation message "Thank you. Your information has been submitted" or you see the message "Please correct the highlighted fields".

Submit

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