Application for Assistance

Let's get you the help you need

This takes about 5 minutes. All information is confidential. A case officer will contact you within 48 hours.

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1. About you

Tell us who we're helping.

Full legal name *

Please enter your full name.

Email address *

Please enter a valid email address.

Phone number *

Please enter a valid 10-digit phone number.

Preferred way to reach you

We serve applicants across the United States.

Street address *

Please enter your street address.

City *

Please enter your city.

State *

2-letter code.

ZIP code *

5-digit ZIP.

Choose the program that fits best. If unsure, pick "Other" and we'll route you.

Type of assistance *

Please select a type of assistance.

Number of people in household *

Please select household size.

Monthly household income *

Please select an income range.

Briefly describe your situation *

Please describe your situation (at least 30 characters).

Shared only with your case officer and our review team.

These help us serve you better.

How did you hear about New Life?

I agree to be contacted by phone, email, or text about my application and I have read the Privacy Policy. *

You must agree to be contacted to continue.

I confirm the information I've provided is accurate and complete to the best of my knowledge. *

Please confirm the accuracy of your information.

You'll receive a confirmation email with your reference code within a few minutes.