B.R.I.D.G.E Emergency Assistance Form

All information will remain confidential between the applicant and B.R.I.D.G.E Project leadership.

Response time is typically 24–48 hours.

If your situation is urgent, please email us directly at: contact@bridgeproject.org (placeholder).

Full Name *

Preferred Language *

Contact Information *

Household Size *

Nature of Crisis *

Rent / Eviction Utility Shut-off Food Insecurity Medical Expense Childcare Emergency Other

Employment Status *

Full-time Part-time Unemployed Unable to work

Total Monthly Income *

Proof of Income *

Proof of Crisis * Or explain your proof:

Please explain your situation in detail *

If you cannot answer a question, you may write N/A.