Support Request

Please complete this online form and an HFCF representative will contact you.

HFCF only assists families in the Monmouth County area
People in need may only apply once for a grant from HFCF
The Board reviews all applications. Please allow 3-4 weeks for processing and payment
Please make sure the new consent form is reviewed and signed before submitting
If you are requesting assistance for a specific bill, then the invoice must be included or application will be denied
HFCF can help with the following but not limited to, rent (only with a copy of a signed, legal lease), child care, utilities, cable, phone, auto expenses, insurance, food & gas gift cards, medical bills, prescription co-pays, etc. However we do not help pay credit cards or give money directly to an applicant.

Date(Required)

Applicant Information

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Email(Required)

Age

Male / Female(Required)

Male

Female

Please provide your children's names and ages:(Required)

Medical information

Medical Information Diagnosis (If Applicable):

Doctor Name(Required)

Primary Hospital(Required)

Current Situation

Current issues resulting in need to help understand the big picture: (Please give a detailed description of daily situation i.e. Job/work kids, living circumstance, family situation, and insurance):(Required)

Area in which help is needed most and financial amounts– be as specific as possible and PRIORITIZE your needs: (transportation, prescription/medical, utilities, rent, child care, food, etc): If a Bill needs to be paid, please include a copy of the invoice (ensuring who and where bill needs to be paid). Assistance requested (e.g., Electric bill, or rent – please prioritize list of bills) ,COST (e.g., $150.00)(Required)

Other Resources or Assistance applied for/ received / receiving or denied::(Required)

Application Submission

Please make sure the application is filled out completely and a HFCF representative will contact you. We will need a signed application, include copies of invoices (if applicable), and if it is a medical condition you must include a signed doctor’s note with a diagnosis.

Upload a signed application (if possible) and anything additional

Max. file size: 50 MB.