COVID-19 Need Help Request Food & MARTA - Midtown Assistance Center

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PLEASE NOTE: We are now only working on financial cases from the United Way and City of Atlanta. In order to apply for assistance with rent and/or utilities you must fill out their form at https://relief.uwga.org/  

This form is no longer for financial assistance and is primarily for Food, MARTA and work clothes/shoes.

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PLEASE NOTE THE FORMATS OF FIELDS FOR YOUR ANSWERS (DASHES, SLASHES, ETC.) THE DATABASE WILL NOT ACCEPT ANSWERS OUT OF FORMAT OR OUT OF DATE.

Filling out this form does not guarantee services. If we are unable to assist you we will do our best to give you information on other assistance resources. Fields with a red asterisk * are required.
Personal Information










Address












Landlord and Rental information







TOTAL HOUSEHOLD INCOME PER MONTH                                                                                                                                            What was your total household income after taxes  BEFORE THE COVID-19 pandemic?                                                                ENTER NUMBERS ONLY - NO DECIMALS  - if none enter 0

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MAC Assistance Requests



Your Personal Story

Release of Information

AFTER YOU SUBMIT BELOW YOU MUST SIGN ON THE NEXT PAGE. Scroll all the way down to the bottom of the page. You will be asked for your E-Signature. You will have to sign and enter your name and email again. It will send 2 emails - a notification and a confirmation email to the email address you provide. You must verify (click) the link in your confirmation email with subject "Verify Signed Response" from no-reply@formassembly.com to complete the application for assistance. Please check to make sure your email address is correct. Sometimes these emails are going to Junk/Spam folders, so please look there as well.