You are here

Emergency Shelter Assistance Grant (ESAG) Application

Al GAMEA

Emergency Shelter Assistance Grant (ESAG)

Application HOW TO APPLY

IMPORTANT: We will accept your application if it contains your name and address (if you have one) on page 1 and your signature on page 2. This minimal information will establish your application filing date. However, the remaining information on the form must be completed, and we must interview you to determine your eligibility. If you are approved, you will receive check seven business days after your interview. Disbursements are at the sole discretion of the Al GAMEA Board of Directors.

Al GAMEA Emergency Shelter Assistance Grant is one time only. You may not receive ESAG grant more than one (1) time.

Please try to answer all the questions on the application. The more information we have, the more quickly we will be able to act on your application. If you aren’t sure what a question means or how to answer it, leave it blank and we will talk about it during your interview. After we receive your application, we will contact you for an interview and ask you more questions. This interview will take place either in the office where you returned your application or at confidential location near you. If you need an interpreter to help you complete this form or for the interview, tell us and we will arrange for one. Below we list the types of things you will need to provide for your application. Please look at the list and gather the information required.

YOU MAY QUALIFY FOR ESAG IF:

  • Your income and money in the bank add up to less than your monthly housing expenses.
  • Your monthly income is less than $800 and your money in the bank is $300 or less.
  • Your monthly rental is less than $500 and less than your money in the bank.

To apply for ESAG, you need to prove your income, expenses and other information. You only need to prove information that applies to you. For example, if you do not have a job, then you do not need to worry about earned income in the list below.

When you get ESAG, you will be given a check, made payable approved payee (landlord, car loan, car insurance, etc.)

Things you must provide, if they apply to you, to receive Emergency Shelter Assistance Grant

  1. Proof of Identity: Driver’s license, birth certificate or other proof of your identity.
  2. Proof of Michigan Residence: Mortgage, tax, homeowners insurance or utility bills, rent receipt or lease. If you are homeless, a collateral contact, motor vehicle registration, statement from a shelter or a statement from the person you are staying with temporarily.
  3. Earned Income: Pay stubs or written statement from employer on letterhead showing income before taxes for the past four weeks.
  4. Other Income: Most recent copy of Social Security check or copy of award letter, proof of unemployment compensation, workers’ compensation, pension, child support or alimony.
  5. Housing Costs: The amount you pay for housing can be shown by your rent receipt or lease agreement.
  6. Utilities: The type of utility expenses you pay can be shown by bills for oil, gas, electricity, telephone (including cellular phone), or bills for other utility expenses such as garbage disposal, wood or coal.

Please bring these documents to your interview. Pay stubs, utility bills and other proof must not be more than four weeks old from the day that you turn in your application.

Information About You

Information About Where You Live

Earnings

Other Income

Shelter Expenses

Utility Expenses


NOTICE OF RIGHTS, RESPONSIBILITIES AND PENALTIES (PLEASE READ CAREFULLY)

I certify under penalty of perjury that I have read, or have had read to me, the information in this application and my answers to the questions in this application and such answers are true and complete to the best of my knowledge. I also certify under penalty of perjury that my answers on any supplement I may complete in the future will be true and complete to the best of my knowledge. I understand that giving false or misleading statements or misrepresenting, hiding or withholding facts, either orally or in writing, to establish eligibility for the AL GAMEA ESAG is fraud.

I give permission to AL GAMEA to verify and investigate the information I have given that relates to my eligibility for assistance. I give permission to AL GAMEA to get any records or data and to verify information given on this application with other agencies, including federal and state agencies, local housing authorities, out-of-state welfare departments and financial institutions. I also give permission to these agencies to give to AL GAMEA information about my household that concerns my ESAG.

To file a complaint, write to AL GAMEA C/O President of the board, P.O. Box: 471, Hazel Park, Mi 48030

By submitting this application, I hereby certify under penalty of perjury that I have read (or have had read to me) and I understand and agree to the “Rights and Responsibilities,” and the answers in this application and any additional documents I provide to the Department in the future are accurate and complete to the best of my knowledge. I have read the ESAG Penalty Warning in my primary language, have had it read to me or have had it interpreted for me.