Emergency Financial Services

piggy bankAre you HIV-positive and have trouble making ends meet?

Our new program offers both one-time emergency financial assistance and short-term assistance with utilities, housing, food, transportation, medicine or other emergency needs. We may not be able to cover every type of emergency expense, but we would be glad to talk with you to see if we can help. We can also provide you with referrals and suggestions for other sources of help.

To qualify, you must be HIV-positive and reside in the Tri-County region (Putnam, Rockland, or Westchester counties of the Hudson Valley) or one of the five boroughs of New York City (the Bronx, Brooklyn, Manhattan, Queens, or Staten Island).

For more information, contact LaShonda Cyrus at: (914) 785-8356.

ENROLLMENT FORMS

These forms must be completed in full to apply for HVCS’ Emergency Financial Services (EFS) program. Email completed forms to: transportation@hudsonvalleycs.org  or FAX them to (914) 345-3106.

30.008b EFS-NYC Program Checklist (MS Word)

1.004a Clients Rights and Responsibilities (PDF)

1.005a doh-2557 (PDF)

1.008b Client Communication Form English (PDF)

30.001a Eliglibility Attestation Form (MS Word)

30.002a Intake Assessment (PDF)

30.002b Common Demographics Fillable (MS Word)

30.004a Request for Emergency Financial Services (MS Word)

30.008c Payor of Last Resort Attestation (MS Word)

W9 Form (PDF)