TELL US ABOUT YOURSELF

We do have some "top-level" verifiable qualifications that applicants MUST meet for further consideration. These are:

Resident of Franklin County
Currently Employed - 40-hours/week
Valid Driver's license
Insured OR Insurable (able to be insured and can maintain auto insurance coverage)
Current on auto payments or full ownership status

First Name *

Last Name *

Email *

Phone *

Address *

City *

State *

Postal code *

Are you a resident of Franklin County, Ohio? *

Are you currently employed 40-hours per week? (must be verifiable) *

Do you have a valid driver's license? *

Yes

If so, please include your Driver's License number.

Are you current on auto payments, or do you have full ownership of your vehicle? *

Yes

Do You Have Valid Auto Insurance? (Must Be Verifiable) *

YOUR VEHICLE

Vehicle YEAR *

Vehicle MAKE *

Vehicle MODEL *

Is the vehicle drivable or running at all? *

Briefly share your best understanding of the mechanical issue. *

Have you received a repair estimate? *

If you've received an estimate, please include that information here (including the repair shop info)

Was damage the result of an accident? *

If so, please indicate the date of the incident.

Was insurance contacted?

YOUR SITUATION

Here we will ask a few questions about your need, and your situation.

What is the name, phone number, and email of your current employer? *

How long have you worked at your current job? *

Do you have dependents? *

If you have dependents, how many and what ages? *

How are your transportation needs currently being met? *

Please describe your situation, regarding your hardship and/or need. *

Is there anything else you would like to add? If referred by a social/case worker, please include their name and contact information here.