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 receive assistance once in 12 months and no more than 2 times total. 

Please complete the 2 steps below to apply for the Mazur Fund Financial Assistance grant.

• Step 1: Submit the online form below. Make sure to fill out all the required fields.
• Step 2: Send the following supporting documentation to apply@jssmadison.org or fax them to 608-819-6550:
  • Dane County Residency proof (lease, current utility bill)
  • Two 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 (only if you are requesting help with car repairs)

Your initial request and supporting documents will be reviewed by Caren Minkoff, Social Worker, MSW, who coordinates the Tim & Kathy Mazur Fund.

Please note that if your documents are not submitted within two weeks of your initial request submission, your application will be automatically closed, and you will need to reapply.

Please note that there is a very high volume of requests and it may take several weeks to contact all applicants.

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 apply@jssmadison.org. Please also note that all JSS visits are by appointment only and walk-ins will not be accepted.

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

of you your

Amount requested: *

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