Apply Online for Assistance

We are a non-denominational, walk-in, year-round emergency resource center servicing the Davison, Goodrich, and Otisville areas. We have recently expanded our coverage to also include the eastern side of Genesee County from Center Rd and east to the Lapeer County Line.

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 drivers license for services the first time and you MUST COME IN to receive services. We do require re-certifying all info every 6 months .

Application for Client Services

Application for Client Services

"*" indicates required fields

MM slash DD slash YYYY
Is anyone in your household a Veteran?
I am In need of :*
Applying For :
Rent Eviction Total Amount Owed
RENT / EVICTION $ Amount Needed
Utilities Total Amt. Owed
UTILITIES $ Amount Needed
Consumers Acct Number
OTHER
 
Name*
Address*
Email*
Date Of Birth
Spouse or Sig. Other Name Living In the Home
Date Of Birth
List 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
 
LIST Other people living in the home
Name
DOB
Realtionship
 

INCOME

Please List ALL INCOME FROM ENTIRE HOUSEHOLD -All Members - EVERYONE -including , Work - Soc Sec, Disability, Unemployment , SSI, Food Stamps, MISHDA , Child Support , CLICK ON THE PLUS SIGN ++ TO ADD A NEW LINE ++
List*
Who's Income
From what company
Gross Amount Received
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 ?
 
Drop files here or
Accepted file types: jpg, gif, png, pdf, Max. file size: 8 MB, Max. files: 5.
    Consent*

    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.


    Privacy Policy / Waiver

    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 information to the Genesee County Department of Social Services, Lapeer County Department of Social Services and/or any agencies that might be assisting me. 
    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.