The Colony COVID-19 Relief Fund

Do you live in The Colony, TX?*
- Yes
- No
Assistance is currently ONLY available to The Colony, TX residents.

For additional resources in Denton County please go to United Way Denton - COVID-19 Resources.
Have you received a total of 3 months of rental/utility assistance from any agency in Denton County (including Next Steps)?
- Yes
- No
At this time we are only able to offer 3 months of rental/utility assistance. If you hear about another COVID stimulus package approval please feel free to check back.
Client Information
Next Steps believes in equal rights for all and does not discriminate on the basis of race, color, religion, national origin, sex, disability, sexual orientation, or gender identity.
Have you lost your job, hours or income because of COVID-19
- Yes
- No
Name*
First Middle Last Suffix
SSN*
Date of Birth*
Date Format: MM slash DD slash YYYY
Gender*
- Female
- Male
Are you pregnant?
- Yes
- No
The Colony Street Address*
**NOTE: ONLY AVAILABLE FOR RESIDENTS OF THE COLONY, TX**

Street Address City State ZIP Code
Please note that due to fund restrictions this is only available to residents of The Colony, TX 75056.
Please list the ages of everyone in the household
Phone Number*
Email*
I identify my race as:*
Hispanic/Latino*
- Yes
- No
Veteran
Are you a veteran?*
- Yes
- No
Domestic Violence
Are you a domestic violence victim/survivor?*
- Yes
- No
If yes, when did the experience occur?
If yes, are you currently fleeing?
- Yes
- No
Disabling Condition
Do you have a disabling condition?*
- Yes
- No
If yes, please explain
If yes, is the disability expected to be of long-continued and indefinite duration and substantially impair your ability to live independently?
- Yes
- No
Developmental Disability
Do you have a developmental disability?*
- Yes
- No
If yes, is the disability expected to substantially impair your ability to live independently?
- Yes
- No
Chronic Health Condition
Do you have a chronic health condition?
- Yes
- No
If yes, is the chronic health condition expected to be of long-continued and indefinite duration and substantially impair your ability to live independently?
- Yes
- No
HIV/Aids
HIV/Aids*
- Yes
- No
If yes, is the disability expected to substantially impair your ability to live independently?
- Yes
- No
Mental Health
Mental health problem*
- Yes
- No
If yes, is the chronic health condition expected to be of long-continued and indefinite duration and substantially impair your ability to live independently?
- Yes
- No
Substance Abuse
Substance abuse problem*
- Alcohol abuse
- Drug abuse
- Alcohol and drug abuse
- None
For alcohol abuse, drug abuse, or both alcohol and drug abuse is the substance abuse problem expected to be of long-continued and indefinite duration and substantially impair your ability to live independently?
- Yes
- No
Income
Have you applied for unemployment?
- Yes
- No
If yes, please attach a screenshot of your application
If yes, please attach a screenshot of a letter, email, or text from your employer
Do you receive income from the following source(s)*
- Earned income
- Unemployment insurance
- Supplemental Security Income (SSI)
- Social Security Disability Income (SSDI)
- VA Service-Connected Disability Compensation
- VA Non-Service-Connected Disability Pension
- Private Disability Insurance
- Workers Compensation
- Temporary Assistance for Needy Assistance (TANF)
- General Assistance (GA)
- Retirement Income from Social Security
- Pension or retirement income from a former job
- Child support
- Alimony or other spousal support
- Other
- None
If yes, list all income sources and monthly amount
Attach a copy of your current bank balance (screenshot or your most current bank statement)
Non-cash Benefits
Do you have any non-cash benefits from the following source(s)*
- Supplemental Nutrition Assistance Program (SNAP)
- Special Supplemental Nutrition Program From Women, Infants, and Children (WIC)
- TANF Childcare Services
- Other
- None
If yes, list all benefit sources and monthly amount
Health Insurance
Are you currently covered by health insurance?*
- Yes
- No
If yes, choose from the following list
- Medicaid
- Medicare
- State Children's Health Insurance
- VA Medical Services
- Employer-provided health insurance
- Health insurance obtained through COBRA
- Private pay health insurance
- State health insurance for adults
- Indian health services program
- Other
If other, please specify
Next Steps
How did you hear about Next Steps?
Have you been helped by Next Steps in the past?
- Yes
- No
When?
Date Format: MM slash DD slash YYYY
Explain your situation
I need emergency assistance from Next Steps with...*
Approximate financial need*
Enter a dollar ($) amount. If no financial assistance is needed, please enter a 0.
If asking for housing assistance, how many months are you behind?
If behind, which months are you behind?
- January
- February
- March
- April
- May
- June
- July
- August
- September
- October
- November
- December
If asking for housing assistance, do you owe late fees and how much?
If asking for housing assistance, please attach a copy of the front page of your lease
Landlord Name
Landlord Address
Landlord Phone Number
If you live in a rental HOME (not an apartment), Please download this form (W9 Form) and have your landlord sign it, and return it to docs@nextstepstc.org. Rent checks will not be released until this has been completed.
Consent*
Filling out this form does not guarantee financial assistance from Next Steps. All requests will be reviewed by a committee and I will be contacted within 2 business days. I understand to my information will be shared with United Way in order to receive help.
I understand and agree

(972) 445-7770

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Client Information

Please note that due to fund restrictions this is only available to residents of The Colony, TX 75056.

Veteran

Domestic Violence

Disabling Condition

Developmental Disability

Chronic Health Condition

HIV/Aids

Mental Health

Substance Abuse

Income

Non-cash Benefits

Health Insurance

Next Steps

Explain your situation