PRE-QUALIFICATION - City & County of Honolulu: Household Hardship Relief Fund

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Thank you for calling 211 to inquire about the City & County of Honolulu's Household Hardship Relief Fund (HHRF), operated by Aloha United Way. This form will be used to assess qualifications and eligibility requirements.

The purpose of the program is to provide emergency monetary assistance to Households directly affected by the impact of the Coronavirus (COVID-19). Eligible applicants shall receive hardship relief payments for basic necessities, such as rent, mortgage, electric, gas, eldercare, childcare, or such other necessary expenses, provided that such Households can demonstrate that they are suffering economic hardship and inability to pay for such needs due to the impact of COVID-19.

Please ensure that all questions are answered accurately and to the best of your knowledge.

First Name *

Last Name *

Middle Initial

Phone Number *

Format: 0000000000 (no dashes please!)

For what areas are you seeking financial assistance? *

Please select all that apply.

Rent Payment

Mortgage Payment

Utility Service Payment (gas or electric)

Licensed Eldercare

Licensed Childcare

Other:

Required

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