Financial Assistance Initial Request

The Tim and Kathy Mazur Fund is designed to provide direct financial assistance to those who may be in danger of losing their housing or job due to a temporary obstacle. The Fund is for Dane County residents only, regardless of their faith, age, ethnicity, or race. You can only apply for this fund once in 12 months and no more than 2 times total. 

Instructions

1. Please fill out the form below to submit your initial request. This request will be sent to Caren Minkoff, Social Worker, MSW, who coordinates the Tim & Kathy Mazur Fund.
2. Once your initial request is sent, you will receive a confirmation message with a list of required documents:
   • Dane County Residency proof (lease, current utility bill)
   • 2 most recent bank statements
   • 2 most recent pay stubs for all earners in household or verification of your sources of income (such as social security award letter, unemployment statements, etc.)
   • 2 estimates (for car repairs only)
3. When you have the documents ready, please email them to Caren@jssmadison.org or fax them to 608-819-6550.
4. Once your documents are received, Caren will contact you and schedule an intake appointment to complete your financial assistance application.
5. If you have any questions about the application process or wish to follow up on the status of your application, please call our office at 608-442-4081 or email Caren (email is preferred and has quicker response times). Please also note that all JSS visits are by appointment only and walk-ins will not be accepted.
6. It is important to understand that this process takes time – please be patient and know that there is a limitation on funding and that funding is NOT guaranteed. Grants are for less than $1,000.

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Name *

First

Last

Address

Phone Number *

Email *

Are you a Dane County Resident? (Assistance provided to Dane County Residents only) *

• Yes
• No

How did you hear about the fund? *

• Tenant Resource Center
• Urban Triage
• Way Forward
• Other (please write below):

Other:

Have you received financial assistance from this fund in the last 12 months? *

• Yes
• No

Amount requested: *

need: Including only

Are you currently employed? *

• Yes
• No

If no, please list your sources of income:

Including yourself, how many adults live in your household? *

How many children under 18 are in your household? *

What type of financial assistance are you seeking? (Check all that apply) *

• Current Rent
• Back Rent
• Security Deposit
• First Month’s Rent
• Utility Bill
• Other (please explain below):

Provide a short explanation about the circumstances of your financial need: *

If we are only able to partially assist, please explain how you would pay the rest of your balance: *

If we can assist, how will this stabilize you and help you maintain your housing? *

*

• I acknowledge I have read and understand the Mazur Fund initial request, application instructions and rules.

*

• I understand that my application will not be processed until I send all required documents.

*

• I confirm that I am a Dane County resident.

Submit