Emergency Assistance

We can give you what you need to get ahead!

Emergency Assistance can help you:

• Avoid utility shut down
• Avoid eviction
• Pay first month’s rent
• Cover costs of prescription drugs

To receive emergency assistance you must meet the federal eligibility guidelines.

Applicants are only permitted to receive emergency assistance once annually.

Each case is reviewed individually by our staff. The amount given is dependent on funds available.

Contact L.E.A.P’s Emergency Assistance staff by calling 518-746-2391 or email us at [email protected] to learn more.

To find out if L.E.A.P. can help, begin an application for emergency assistance here. 

Assistance Application

Please complete the application below as accurately as possible. You may be asked to provide proof of income or complete other documentation once you arrive at the office.

• Contact Information

• Name*
  First Last
• Email
• Address*
  Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code
• Home Phone*
• Cell Phone

• Household Information

• Number in Household*
• Household Type*
  Single Parent/FemaleSingle Parent/MaleTwo ParentSingle PersonCouple/ No ChildrenOther
  Please select the option that describes your household the best.
• Household Members*

  Name	Age	Gender (M/F)	Disabled (Y/N)	Ethnicity	Health Insurance (Y/N)	Highest Level of Education	Relationship to Applicant

  Please use the following to complete this section of the application. Disabled- Yes or No Ethnicity: B-African American, W- Caucasian/White, H-Hispanic, NA- Native American, A- Asian, O- Other, M-two or more options. Education: Highest grade level completed, HS graduate, College graduate, Post High School Training, or Unknown
• Please select your current living situation:*
  RentHome OwnerHomeless
• Name of Landlord or Mortgage Company*
• Address of Landlord or Mortgage Company*
  Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code
• Phone Number of Landlord or Mortgage Company*
• Monthly Rent/Mortgage Payment*

• Household Income

  Please be ready to provide proof of the last four weeks of income for yourself and ALL household members.
• Household Sources of Income*
  • Employment
  • Alimony
  • Child Support
  • Interest or Dividends
  • Pension/Retirement
  • Other Person's Contribution
  • Rental Income/ Room & Board
  • Unemployment Insurance
  • Safety Net
  • Social Security/ Social Security Disability
  • Social Security Insurance
  • TANF
  • Veteran's Benefits
  • Worker's Comp
  • Other
  Please select all that apply.
• Do you receive food stamps?*
  YesNo
• Are you a current Head Start Family?*
  YesNo
• If appropriate, are you enrolled in WIC?*
  YesNo
• Do you receive Medicaid?*
  YesNo
• What services can LEAP provide you with?*
  • Emergency Assistance (help with utilities, eviction, other bills)
  • Emergency Food Pantry
  • Clothing
  Select all that apply.
• Please describe your Emergency Need and steps you have taken to alleviate the emergency.*
  You will need to provide documentation such as notices, bills, letters or other relevant paperwork when you come into our office.
• If there is no Household Income or your expenses exceed your income, please explain how you have been meeting your monthly expenses.*
• Declaration*
  By checking this box, I the applicant do solemnly swear that the information provided is true, correct, and complete to the best of my knowledge. I understand that I any false statements or misrepresentations may result in my being found ineligible for emergency assistance. I consent to any inquiries to verify or confirm the information provided on this application.
• Comments
  This field is for validation purposes and should be left unchanged.

 This is required information, but if you have questions about the application please call us.  We are available to answer your questions between 8:30am-4pm at the phone number listed above.