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Emergency Loan Fund (ELF) - Checklist for EAP-ELF

Print this list and bring the completed form to EAP

Name:______________________________________ Date:________________

Have you exhausted all of the following possibilities?

           Asked Relatives/Friends

Comments:

________________________________________________________________
________________________________________________________________

 ____ WIC
(Women, Infants, and Children)

Food Assistance
Outcome: ____

 ____ DHS – State Assistance

Outcome: ____

 ____ Fuel Assistance

Food Assistance
Outcome: ____

 ____ Town Assistance

Food Assistance
Outcome: ____

 

Please bring the following to your EAP/ELF appointment:

___ Bill from vendor( up to two).  Note: We apologize, but checks cannot be made out to employee; it must be made out to a vendor.

___ Your current paycheck stub(s) as well as pay stubs from all contributing members of your household.

___ Statements from all checking and/or savings – printed within 7 days of your  appointment.

___ Monthly Budget

___ If for vehicle repair, a minimum of 2 estimates

___ List credit card balances & other consumer debts


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