EFAA Financial Help Request Form

What is your preferred language? Cuál es su idioma preferido?

Full Name (as shown on your ID)

First Name(s)Middle Name(s)Last Name(s)

Date of Birth

MonthDayYear

What is your current address, or the address you have been approved to move into?

Street Address

Unit Number (if applicable)

CityState

Zip Code

What is your current address or what was your prior address before experiencing homelessness

Street Address

Unit Number (if applicable)

CityState

Zip Code

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Email ( If you do not have an email write Noemail@noemail.com)

example@example.com

NO EMAIL- MUST SEND A TEXT MESSAGE

example@example.com

What type of Financial Assistance are you looking for? EFAA prioritizes rental assistance over any other assistance.

Hidden Field

2 Hidden Field

EFAA will begin utility assistance walk-in hours starting October, 6th: Mondays, Tuesdays, Thursdays & Fridays, 12:00–3:00pm. We’ll see 4 households per day. Please bring a photo ID and your past-due gas or electric bill.

If you are only requesting utility assistance today, you do not need to submit an online form.

Please review the following eligibility requirements:

You must live within EFAA’s service area.
You must have received a past due bill, disconnection notice, or shut-off notice from your utility company. Please bring a physical or electronic copy, if possible.
You must not have received Energy Outreach Colorado (EOC) assistance from any agency between October 1, 2025, and September 30, 2026.
You must present a photo ID.

You can also call Xcel at 800-895-4999 to set up a payment plan.

Financial Assistance for Vision Expenses

EFAA can provide financial assistance for eye exams and eyeglasses. We may be able to cover up to $500.00 for each eligible family member for a future expense.

If you have Medicaid, Medicare, or any other health insurance that covers eye exams, please use it to pay for that expense.

You can come into our Boulder office without a reservation or appointment to request assistance on the following days: Monday, Tuesday, Thursday, or Friday from 12:00–3:00 PM.

Note:

We have only 3 slots available per day; assistance is provided on a first-come, first-served basis.
What do you need to bring? An estimate from your eye doctor showing the services you need and the total cost.
If you arrive without the required documents, we will ask you to return on a different day once you have everything needed to process your request.

If your eye doctor is not listed below, please ask them for a W9 form and bring it to EFAA.

Vendors we frequently work with:
Vantage Vision Care, Dr. Lowell C. Steinberg
3100 Arapahoe Ave, Suite #101
Boulder, CO 80303
Phone: 303-447-8470

America’s Best
205 Ken Pratt Blvd
Longmont, CO 80501
Phone: 303-532-3056

Vendors We Do NOT Work With

Target Optical
Costco Optical
Walmart Vision Center
Sam’s Club Optical

Financial Assistance for Minor Medical and Dental Expenses

EFAA can provide financial assistance for medical and dental expenses, such as minor medical procedures, necessary medical equipment, dental services, or prescriptions. We can cover up to $1000 per household per calendar year (January 1–December 31).

What’s not covered:

Bills that Medicaid, Medicare, or other health insurance can cover.
Braces, orthodontics, or dental procedures that are for purely cosmetic reasons.
Prescriptions that are controlled substances.

When? You can come into our Boulder office without a reservation or appointment to request assistance on the following days: Monday, Tuesday, Thursday, or Friday from 12:00–3:00 PM. You can also get this assistance during your rent or deposit appointment.

We have only 3 walk-in slots available per day; assistance is provided on a first-come, first-served basis. We can help with one service at a time. Please return to resourcing hours for help with additional services.

What to bring:

An ID with your picture
An estimate from your doctor or dentist showing the services you need and the total cost. It can be electronic or paper. It should be recent--from the last 6 months.
Proof of address (like a utility bill, lease, or bank statement) if you are new to EFAA.
If you arrive without the required documents, we will ask you to return on a different day once you have everything needed to process your request.
If your doctor is not listed below, please ask them for a W9 form and bring it to EFAA.

EFAA makes all payments directly to the provider. Payments can take up to 3 weeks to reach your doctor or dentist.

Vendors we frequently work with and already have W-9s*. These are options; but you can select any provider (except the two noted below).

-Dental Aid 4155 Darley Ave, Boulder, CO 80305 (303) 499-7072
-Boulder Community Health 4747 Arapahoe Ave, Boulder, CO 80303 (303) 415-7000
-Clinica Family Health & Wellness 2525 13th St, Boulder, CO 80304 (303) 650-4460
-Comfort Dental – Boulder 3400 Arapahoe Rd, Boulder, CO 80303 (303) 444-2129
-Comfort Dental – Louisville 994 W Dillon Rd #400, Louisville, CO 80027 (303) 673-0500

*EFAA is not responsible for the services provided.

Vendors We Do NOT Work With:
-Health Images
-Best Buy (hearing aids)

Do you have a demand for rent or mortgage?

Do you have a court date for eviction?

What month rent or mortgage are you requesting assistance for?

On your demand, how much do you currently owe?

On your demand, when is payment due?

MonthDayYear

Please upload a photo or file of your demand letter. Make sure the photo or file you upload is a clear image in order to review your request.

Please upload a photo or file of your acceptance letter or lease agreement. We will need a clear image in order to review your request.

Property Tax Information

Acceptable forms include:

Document showing the property tax amount & due date

Examples:

Property Tax Statement or Bill
Notice of Valuation (NOV)
Certificate of Taxes Due (CTD)
Mortgage Statement (showing property tax escrow)

EFAA is not able to accept:

Verbal statements or handwritten notes about property taxes
Text messages or emails without official attachments or documentation
Screenshots of online portals or apps that don’t show the full tax amount and due date
Past-due notices without clear tax breakdown or payment instructions
Documents that don’t include the your name or property information
Estimates of taxes rather than actual statements or bills
Generic payment receipts without itemization (e.g., partial rent receipts not specifying taxes)

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Información sobre el impuesto sobre la propiedad.

Los formularios aceptables incluyen:

Documento que muestra el importe del impuesto sobre bienes inmuebles y la fecha de vencimiento.

Ejemplos:

Declaración o factura del impuesto sobre la propiedad
Notificación de valoración (NOV)
Certificado de impuestos adeudados (CTD)
Declaración hipotecaria (que muestre el depósito en garantía del impuesto sobre la propiedad)

La EFAA no puede aceptar:

Declaraciones verbales o notas manuscritas sobre impuestos sobre la propiedad
Mensajes de texto o correos electrónicos sin archivos adjuntos oficiales o documentación
Capturas de pantalla de portales o aplicaciones en línea que no muestran el
importe total del impuesto y la fecha de vencimiento
Notificaciones de vencimiento sin un desglose claro de los impuestos o instrucciones de pago
Documentos que no incluyen su nombre o información sobre la propiedad
Estimaciones de impuestos en lugar de declaraciones o facturas reales
Recibos de pago genéricos sin desglose (por ejemplo, recibos de alquiler parciales que no especifican los impuestos)

Please upload a photo or file of your property tax information. We will need a clear image in order to review your request.

Which best describes your current situation?

Do you have children under the age of 18 living in your home?

Are your children enrolled in school? If yes, please share which school district.

Do you identify as someone with a disability?

Are you 60 years of age or older?

At this time, EFAA is not able to schedule you an appointment for the assistance you requested.

Please explore the following resources:

Boulder County Resource Hub: https://boco.findhelp.com/
Findhelp.org: Enter your ZIP code to locate nearby services https://www.findhelp.org/
Boulder County Housing Helpline:303-441-1206 housinghelpline@bouldercounty.gov
Call 211 or chat on their website for a wide range of support.
PEAK: Apply for public benefits like health insurance, cash, and food assistance https://colorado.gov/PEAK
Boulder County Immigration Resources:https://bouldercounty.gov/government/about-boulder-county/immigrant-resources/

Older Adult’s Resources:

City of Boulder East Age Well Center for Older Adults Phone Number: 303-413-7290
City of Boulder West Age Well Center for Older Adults Phone Number: 303-441-3148
Boulder County AREA AGENCY ON AGING (AAA) Phone Number: 303-441-1617

Have a demand for rent & are a family or individual-Score

Have demand for rent & are an older adult-Score

Have a demand for rent & have a disability- Score

Financial Assistance Request & are a family or are an individual- Score

Financial Assistance Request & are an older adult-Score

Financial Assistance Request & have a disability-Score

Are a family or individual & Past/Current/Next Rent Due-Score

Are an older adult & Past/Current/Next Rent Due-Score

Have a disability & Past/Current/Next Rent Due-Score

Final Score

EFAA serves the Mountain Communities within the Boulder Valley School District (BVSD) in Boulder County.

Next steps:

Once you submit this form it will be sent directly over to our Mountain Liaison Navigator.

You can also reach out directly by texting or calling 720-422-7813 with any additional questions.

In order to schedule a housing resourcing appointment, we need the following documents:

Para poder programar una cita para asistencia de vivienda, necesitamos lo siguiente:

Please provide a copy of picture ID for all adults in your household. ____________________________________________________________________________________ Por favor proporcione una copia de identificación con foto por cada adulto en su hogar.

Please provide proof of residency in the city of Boulder. We can accept a copy of your current or most recent lease, a piece of mail (that shows date, your name, and address), or verification that your children are registered in BVSD. ____________________________________________________________________________________ También necesitamos un comprobante de residencia en la ciudad de Boulder. Puede ser una copia de su contrato de arrendamiento actual o más reciente, correo (que incluya la fecha, su nombre y su dirección), o verificación de que sus hijos están inscritos en BVSD.

Shelter & Housing Resources to Explore:

Boulder County Housing Helpline

List of available rentals in Boulder County updated weekly.
Website: Housing Helpline
Contact: housinghelpline@bouldercounty.gov
Phone:303-441-1206
Details: Visit the website first and select the tab that best matches your need.

Emergency Shelters:

Safe Shelter of St. Vrain Valley (Family Shelter & Individuals & Domestic Violence)

Address: Located in Longmont, CO 80502
Phone: 303-772-0432
24/7 Crisis Line: 303-772-4422
Website: https://www.safeshelterofstvrain.org/

General Shelters:

All Roads Shelter (Individual Adults & in Boulder County)

Address:4869 Broadway, Boulder, CO 80304.
Phone: 303-442-4646
Website: https://allroadsboco.org/

Hope (Emergency Shelter)

Address:Messiah Lutheran Church 1335 Francis StLongmont, CO 80501 and 2000 Pike Rd Unit A Longmont, CO 80501
Phone: 720-494-4673, after 5PM 720-453-6999
Website:https://hopeforlongmont.org/programs/

Samaritan House Fort Collins (Family Shelter & Individuals)

Address: 460 Linden Center Dr., Ft. Collins, CO 80524
Phone: 970-484-5010
Website: Samaritan House Fort Collins

Samaritan House Denver (Family Shelter & Adult Women)

Address: 2301 Lawrence St., Denver, CO 80205
Phone: 303-294-0241
Website: https://ccdenver.org/denver-samaritan-house/

Catholic Charities Guadalupe Shelter (Family Shelter & Individuals)

Address: 1442 N 11th Ave., Greeley, CO 80631
Phone: 970-353-6433
Website: https://ccdenver.org/greeley/

Family HomeStead (Family Shelter & Individuals)

Address: 999 Decatur Street Denver, CO 80204
Phone: 303-623-6514
Website:https://familyhomestead.org/

The Delores Project (Serving women, transgender, & nonbinary individuals)

Address: Located in Denver, CO 80201
Phone: 303-534-5411
Website: https://thedeloresproject.org/

Colorado Coalition for the Homeless (Families & Individuals)

Address: 2111 Champa St, Denver, CO 80205
Phone: 303-293-2217
Website: https://www.coloradocoalition.org/
Details: Make an appointment with CCH for case management here

Comitis Crisis Center / Aurora Day Resource Center (Families & Severe weather)

Address: 2178 Victor St, Aurora, Colorado 80045
Phone: 303-341-9160
Website:https://comitiscrisiscenter.org/comitis-crisis-center/

Domestic Violence (DV) Shelters:

Safehouse Progressive Alliance for Nonviolence (SPAN) (DV)

Address: Boulder, CO
Phone: 303-449-8623 and Crisis Line: 303-444-2424
Website:https://www.safehousealliance.org/

Safe Shelter of St. Vrain Valley (Domestic Violence & Family Shelter & Individuals)

Address: Located in Longmont, CO 80502
Phone: 303-772-0432 and 24/7 Crisis Line: 303-772-4422
Website: https://www.safeshelterofstvrain.org/

Maternity Homes:

The Little Flower Maternity Home

Address:Louisville, CO 80027
Phone:720-609-2934
Website:https://littleflowermaternity.org/

Mother House at Haven Ridge Boulder (Pregnant people)

Address: Boulder, CO 80308
Website:https://havenridgeboulder.org/mother-house

You do not live in EFAA's Service Area

Please contact your local Family Resource Center:

Sister Carmen: Lafayette, Louisville, Superior, Erie - Call 303-665-4342
OUR Center: Longmont, Lyons, Niwot, Allenspark, Frederick, Firestone, Mead (St Vrain School District) - Call 303-772-5529
Broomfield FISH: Broomfield - Call 303-465-1600

The following resources may be able to help. This is not a complete list:

State-wide Resources:

Findhelp.org – Enter your zip code to locate services near you.
Call 211, or chat 211 on their website
PEAK – Apply for public benefits like health insurance, cash, and food assistance.
Colorado Emergency Rental Assistance (CERA)

Boulder County Related Resources:

Housing Helpline for Boulder County
Eviction Prevention and Rental Assistance Services (EPRAS) - If you currently have a court date for an eviction, and live in the City of Boulder
Immigrant Resources – Boulder County’s Immigration Resources page.
Personal Finance Program at Boulder County. Free, personalized support.

You are not eligible for EFAA's services at this time.

Please explore the following resources

If you currently have a court date for an eviction and live in the City of Boulder, please contact Eviction Prevention and Rental Assistance Services (EPRAS).
If you owe over $5,000 in rent, Emergency Family Assistance Association (EFAA) is unable to assist at this time. Please contact Colorado Emergency Rental Assistance (CERA) to determine eligibility
Housing Helpline for Boulder County

The following additional resources may be able to help. This is not a complete list:

State-wide Resources:

Findhelp.org – Enter your zip code to locate services near you.
Call 211, or chat 211 on their website
PEAK – Apply for public benefits like health insurance, cash, and food assistance.
Colorado Emergency Rental Assistance (CERA)

Boulder Related Resources:

Housing Helpline for Boulder County
Eviction Prevention and Rental Assistance Services (EPRAS) - If you currently have a court date for an eviction, and live in the City of Boulder
Immigrant Resources – Boulder County’s Immigration Resources page.