Apply Online for Assistance

We are a non-denominational, walk-in, year-round emergency resource center servicing the Aprox. 225 square miles of east Genesee County with our office located in Davison, Mi.

Our Service Area includes the eastern side of Genesee County from Center Rd and east to the Lapeer County Line. ( see map)

Are you in need of food, clothing, utility assistance, rent eviction? You may fill out the application online, even upload your pay stubs etc. HOWEVER, You MUST Bring in the physical copy of your social security cards of all children and driver’s license for services the first time to finish the application process and you MUST COME IN to receive services. We do require re-certifying all info every 6 months.

Have you applied to DHS yet? We will need the DHS determinations to assist with rent or utilities.

Application for Client Services

"*" indicates required fields

TODAY'S Date*

How did you hear about Outreach East ?*

Veteran*

Is anyone in your household a Veteran?

Name of Veteran and Service Branch

I am In need of :*

Food Assistance

Rent/Eviction Assistance

Utility Assistance

Clothing

Other

Total Number in Household*

Applying For :

Rent Eviction Total Amount Owed

RENT / EVICTION $ Amount Needed

Utilities Total Amt. Owed

UTILITIES $ Amount Needed

Consumers Acct Number

OTHER

Name*

First Middle Last

Address*

Street Address City State / Province / Region ZIP / Postal Code

Phone*

Email*

Enter Email Confirm Email

Last 4 Numbers of Social ( Must Still bring in Card)*

Date Of Birth*

DL / Or ID Number

Spouse or Sig. Other Name Living In the Home

First Middle Last

Last 4 Numbers of Soc Sec ( Must Still bring in Card )

Date Of Birth

DL /ID Number –Must still bring in or upload

Phone-2

List ALL Children Under 19 LIVING WITH YOU- CLICK ON PLUS (+)+ TO ADD MORE Lines Click Plus+

Child Name

Date of Birth

Last 4 numbers of Social Sec (Must still bring in Physical Card)

— Girl or Boy

School Name Attending

LIST ALL Other people living in the home

Name

DOB

Realtionship

Does your household receive Food Stamps ? -(will not affect you getting food from us.)*

Amount receiving monthly*

Would you like information or assistance to help apply?*

Yes

INCOME

Please List ALL INCOME FROM ENTIRE HOUSEHOLD -All Members – EVERYONE -including , Work – Soc Sec, Disability, Unemployment , SSI, MISHDA , Child Support , CLICK ON THE PLUS SIGN ( + ) TO ADD A NEW LINE. TYPE , or PERSON’S INCOME ( + )

List*

Who's Income

From what company

Gross Amount Received Per Payday

How Often – Weekly, Bi-weekly,Monthly

RENT / MORTGAGE

List Rent Or Mortgage Info – Add a line ( +) for additional Expenses*

LANDLORD/ Mortgage paid to:

AMOUNT PER MONTH

Note

Court Date?

YOU May Upload your DL, Pay Stub , Proof of Income ——————————-BUT YOU MUST PHYSICALLY BRING IN ALL SS CARDS

Drop files here or

Accepted file types: jpg, gif, png, pdf, Max. file size: 8 MB, Max. files: 5.

If Financial Help Needed – explain how much you have, where else have you been, total amount owed etc.

Other Info or comments:

CAPTCHA

We will usually respond within 24 hours or sooner by email with instructions – please check your junk / spam mail so you do not miss our response. If you have not received a response with 48 hrs please call 810-653-7711 or email us at Outreacheast@hotmail.com

In consideration for receiving assistance from Outreach East, I hereby release, waive, discharge and covenant not to sue Outreach East Inc., or its board, officers, agents, servants, employees, donors, individuals, or businesses (hereinafter referred to as “releasees”) from any and all liability, claims, demands, actions and causes of action whatsoever arising out of, or related to, any loss, damage, or injury, including death, that may be sustained by me, or my children; whether caused by the actions or negligence of the releasees, or otherwise; or caused by any furniture, clothing, other items, foodstuffs, toys, and services provided.
I understand that this release includes children’s toys and the risks associated with the use thereof, including, but not limited to, choking and lead poisoning.
I further agree to indemnify and hold harmless the releasees from any loss, liability, damage or costs including court costs and attorney fees that they may incur in connection with receiving assistance from releasees. It is my express intent that this Waiver of Liability and Hold Harmless Agreement shall bind the members of my family, spouse, and estate. I hereby further agree that this Waiver of Liability and Hold Harmless Agreement shall be construed in accordance with the laws of the State of Michigan. If any portion of this contract is illegal, the illegal portion shall be severed, and the remainder of the contract shall remain in full force and effect.
I hereby give permission for Outreach East and its satellite St. Francis Xavier Parish located in Otisville, MI to request from or give and receive information to the Genesee County Department of Social Services, Lapeer County Department of Social Services and/or any agencies that might be assisting me as well as any company to verify information.
I understand that I can only receive help from one organization and my file will be closed at Outreach East if I use other organizations in addition to Outreach East.
I further understand that any false or misleading statements given will prevent me from obtaining any further assistance.
In signing this agreement, I acknowledge and represent that I have read the foregoing, understand it, and sign it voluntarily. No oral representations, statements, or inducements, apart from the foregoing written agreement, have been made. I execute this agreement for full, adequate and complete consideration intending to be bound by the same.